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General NPI Number Information
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NPI Number | 1477534618
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Entity Type | Organization
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Legal Business Name | LA ESPERANZA PHARMACY CORPORATION
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Dates
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Enumeration Date | 11/06/2005
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 1119 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07114-2501
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Country | US
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Telephone | 973-622-5525
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Fax | 973-622-5540
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Provider Business Mailing Address
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Address Line | 1119 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07114-2501
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Country | US
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Telephone | 973-622-5525
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Fax | 973-622-5540
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BENITA LIM
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Credential |
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Telephone | 201-951-4874
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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 | RS00649900
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License Number State | NJ
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