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General NPI Number Information
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NPI Number | 1861817728
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Entity Type | Organization
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Legal Business Name | FORMULA PHARMACY, INC.
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 11180 W FLAGLER ST STE 2
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City | MIAMI
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State | FL
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Zip | 33174-1250
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Country | US
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Telephone | 305-381-5635
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Fax | 305-381-5971
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Provider Business Mailing Address
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Address Line | 11180 W FLAGLER ST STE 2
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City | MIAMI
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State | FL
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Zip | 33174-1250
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Country | US
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Telephone | 305-381-5635
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Fax | 305-381-5971
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID RICARDO ESPINOSA
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Credential |
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Telephone | 305-381-5635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH27582
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License Number State | FL
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