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General NPI Number Information
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NPI Number | 1619956273
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Entity Type | Organization
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Legal Business Name | AGUIMART CORP
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 432 W 29TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5729
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Country | US
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Telephone | 305-863-6244
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Fax | 305-863-6245
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Provider Business Mailing Address
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Address Line | 432 W 29TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5729
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Country | US
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Telephone | 305-863-6244
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Fax | 305-863-6245
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARIA CRISTINA MARTINEZ
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Credential |
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Telephone | 305-863-6244
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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 | PH21627
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License Number State | FL
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