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General NPI Number Information
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NPI Number | 1477620110
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Entity Type | Organization
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Legal Business Name | DESOTO PHARMACY
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 823 SOUTHERN BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-2529
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Country | US
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Telephone | 561-832-7686
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Fax | 561-832-0230
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Provider Business Mailing Address
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Address Line | 823 SOUTHERN BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-2529
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Country | US
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Telephone | 561-832-7686
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Fax | 561-832-0230
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARIA ANTONIA SOTO
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Credential |
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Telephone | 561-832-7686
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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 | PH7928
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License Number State | FL
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