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General NPI Number Information
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NPI Number | 1861790040
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Entity Type | Organization
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Legal Business Name | FARMACIA LATINA CORP.
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 216 48TH STREET
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City | UNION CITY
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State | NJ
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Zip | 07087
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Country | US
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Telephone | 201-766-5526
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Fax | 201-766-5528
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Provider Business Mailing Address
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Address Line | 216 48TH STREET
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City | UNION CITY
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State | NJ
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Zip | 07087
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Country | US
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Telephone | 201-766-5526
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Fax | 201-766-5528
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. STEPHEN W BLOOMFIELD
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Credential |
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Telephone | 201-766-5526
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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 | RS00710900
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License Number State | NJ
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