=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700328473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TU SALUD PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2016
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 W 46 ST SUITE #5
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-359-4283
-----------------------------------------------------
Fax | 786-899-0980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 W 46 ST SUITE #5
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-359-4283
-----------------------------------------------------
Fax | 786-899-0980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JASON ALONSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-359-4283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH30461
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------