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General NPI Number Information
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NPI Number | 1518346410
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Entity Type | Organization
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Legal Business Name | OPTIMUN RX PHARMACY LLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 6900 W 32ND AVE STE 16
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City | HIALEAH
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State | FL
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Zip | 33018-5228
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Country | US
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Telephone | 305-557-4995
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Fax | 305-557-4074
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Provider Business Mailing Address
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Address Line | 6900 W 32ND AVE STE 16
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City | HIALEAH
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State | FL
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Zip | 33018-5228
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Country | US
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Telephone | 305-557-4995
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Fax | 305-557-4074
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Authorized Official
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Title or Position | OWNER
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Name | YAMILA VAZQUEZ DE LLADO
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Credential |
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Telephone | 305-557-4995
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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 | PH 28374
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License Number State | FL
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