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General NPI Number Information
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NPI Number | 1396099925
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Entity Type | Organization
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Legal Business Name | SOUTH PACIFIC PHARMACY
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 1800 SW 1ST ST SUITE 101
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City | MIAMI
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State | FL
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Zip | 33135-1960
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Country | US
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Telephone | 305-642-0180
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Fax | 305-642-0190
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Provider Business Mailing Address
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Address Line | 1800 SW 1ST ST SUITE 101
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City | MIAMI
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State | FL
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Zip | 33135-1960
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Country | US
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Telephone | 305-642-0180
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Fax | 305-642-0190
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. JUAN CARLOS ARAGON
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Credential |
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Telephone | 305-642-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH24055
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License Number State | FL
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