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General NPI Number Information
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NPI Number | 1881695716
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Entity Type | Organization
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Legal Business Name | INCA NICA INC
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 2442 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-3655
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Country | US
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Telephone | 305-648-3735
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Fax | 305-648-3737
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Provider Business Mailing Address
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Address Line | 2442 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-3655
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Country | US
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Telephone | 305-648-3735
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Fax | 305-648-3737
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIA ELENA ORREGO
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Credential |
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Telephone | 786-556-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH0013232
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License Number State | FL
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