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General NPI Number Information
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NPI Number | 1962846287
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Entity Type | Organization
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Legal Business Name | SAN NICOLAS PHARMACY CORP
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 2140 W FLAGLER ST SUITE 102
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City | MIAMI
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State | FL
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Zip | 33135-5600
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Country | US
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Telephone | 786-953-7224
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Fax | 786-953-7519
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Provider Business Mailing Address
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Address Line | 2140 W FLAGLER ST SUITE 102
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City | MIAMI
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State | FL
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Zip | 33135-5600
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Country | US
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Telephone | 786-953-7224
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Fax | 786-953-7519
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOMAS GARCIA
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Credential |
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Telephone | 786-953-7224
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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 | PH 26799
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License Number State | FL
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