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General NPI Number Information
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NPI Number | 1366844789
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Entity Type | Organization
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Legal Business Name | AQUA PHARMACY INC
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 4243 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1605
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Country | US
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Telephone | 786-409-7503
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Fax | 786-409-7516
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Provider Business Mailing Address
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Address Line | 4243 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1605
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Country | US
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Telephone | 786-409-7503
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Fax | 786-409-7516
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Authorized Official
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Title or Position | OWNER
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Name | AGUSTIN DE CARDENAS
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Credential |
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Telephone | 786-525-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28553
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License Number State | FL
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