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General NPI Number Information
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NPI Number | 1710394465
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Entity Type | Organization
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Legal Business Name | 1ST CLASS PHARMACY OF PALM AVE CORP
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 2760 PALM AVE SUITE 101
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City | HIALEAH
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State | FL
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Zip | 33010-1778
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Country | US
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Telephone | 786-615-6396
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Fax | 786-615-6397
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Provider Business Mailing Address
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Address Line | 2760 PALM AVE SUITE 101
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City | HIALEAH
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State | FL
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Zip | 33010-1778
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Country | US
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Telephone | 786-615-6396
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Fax | 786-615-6397
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINA REYES
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Credential |
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Telephone | 786-615-6396
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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 | FL
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