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General NPI Number Information
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NPI Number | 1407123854
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Entity Type | Organization
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Legal Business Name | CTM PHARMACY INC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 18901 SW 106TH AVE STE 143
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City | CUTLER BAY
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State | FL
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Zip | 33157-7663
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Country | US
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Telephone | 305-252-2056
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Fax | 305-252-2057
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Provider Business Mailing Address
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Address Line | 18901 SW 106TH AVE STE 143
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City | CUTLER BAY
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State | FL
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Zip | 33157-7663
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Country | US
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Telephone | 305-252-2056
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Fax | 305-252-2057
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Authorized Official
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Title or Position | OWNER
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Name | JOSE AZAHARES
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Credential |
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Telephone | 305-252-2056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH25788
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License Number State | FL
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