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General NPI Number Information
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NPI Number | 1629158829
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Entity Type | Organization
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Legal Business Name | TUDELA PHARMACY, INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 10981 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-4412
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Country | US
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Telephone | 305-223-4841
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Fax | 305-223-1006
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Provider Business Mailing Address
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Address Line | 10981 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-4412
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Country | US
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Telephone | 305-223-4841
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Fax | 305-223-1006
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | MARIA MAGADALENA GONZALEZ
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Credential |
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Telephone | 305-223-4841
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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 | PH14292
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License Number State | FL
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