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General NPI Number Information
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NPI Number | 1699191296
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Entity Type | Organization
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Legal Business Name | LA BOTICA PHARMACY INC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 10550 NW 77TH CT STE 109
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2069
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Country | US
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Telephone | 786-703-4284
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Fax | 786-703-7767
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Provider Business Mailing Address
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Address Line | 10550 NW 77TH CT STE 109
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2069
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Country | US
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Telephone | 786-703-4284
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Fax | 786-703-7767
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | EMILYS PRIETO
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Credential |
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Telephone | 786-703-4284
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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 | PH27570
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License Number State | FL
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