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General NPI Number Information
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NPI Number | 1780984443
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Entity Type | Organization
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Legal Business Name | LILY & ROSY PHARMACY DISCOUNT CORP
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 4254 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4108
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Country | US
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Telephone | 305-826-9967
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Fax | 305-826-9969
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Provider Business Mailing Address
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Address Line | 4254 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4108
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Country | US
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Telephone | 305-826-9967
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Fax | 305-826-9969
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARIEL NUEZ
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Credential |
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Telephone | 305-826-9967
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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 | PH25076
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License Number State | FL
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