=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487028502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURA PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2015
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3825 BECK BLVD #701
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-1003
-----------------------------------------------------
Fax | 239-261-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3825 BECK BLVD #701
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-261-1003
-----------------------------------------------------
Fax | 239-261-1004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PTS
-----------------------------------------------------
Name | BRANDON LANTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-731-1690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH29544
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------