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General NPI Number Information
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NPI Number | 1942584271
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Entity Type | Organization
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Legal Business Name | LA ESPERANZA PHARMACY DISCOUNT INC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 5858 W 20TH AVE
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City | HIALEAH
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State | FL
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Zip | 33016-2603
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Country | US
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Telephone | 786-547-8219
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Fax | 786-547-8219
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Provider Business Mailing Address
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Address Line | 5858 W 20TH AVE
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City | HIALEAH
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State | FL
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Zip | 33016-2603
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Country | US
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Telephone | 786-547-8219
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Fax | 786-547-8219
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ALEXIS AVILA
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Credential |
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Telephone | 786-547-8219
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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 | PH25620
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License Number State | FL
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