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General NPI Number Information
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NPI Number | 1932957297
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN PHARMACY LLC
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 10645 NW 7TH AVE STE 104
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City | MIAMI
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State | FL
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Zip | 33150-1067
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Country | US
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Telephone | 786-963-6008
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Fax | 786-963-6209
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Provider Business Mailing Address
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Address Line | 321 NE 90TH ST
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City | EL PORTAL
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State | FL
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Zip | 33138-3125
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Country | US
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Telephone | 954-237-9841
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Fax | 786-963-6209
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Authorized Official
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Title or Position | MANAGER
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Name | MR. NASSER RICHMOND
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Credential | REG. PHARMACIST
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Telephone | 954-237-9841
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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 |
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