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General NPI Number Information
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NPI Number | 1619424512
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Entity Type | Organization
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Legal Business Name | EZ RX HALLANDALE LLC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1550 W 84TH ST #62
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City | HIALEAH
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State | FL
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Zip | 33014-3379
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Country | US
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Telephone | 786-703-5670
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Fax | 786-703-5657
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Provider Business Mailing Address
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Address Line | 1550 W 84TH ST #62
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City | HIALEAH
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State | FL
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Zip | 33014-3379
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Country | US
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Telephone | 786-703-5670
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Fax | 786-703-5657
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Authorized Official
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Title or Position | OWNER
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Name | MIRTHA GONZALEZ
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Credential |
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Telephone | 786-703-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH30285
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License Number State | FL
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