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General NPI Number Information
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NPI Number | 1992097836
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Entity Type | Organization
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Legal Business Name | BETTY PHARMACY INC
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 2500 NW 79TH AVE SUITE 241
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City | DORAL
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State | FL
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Zip | 33122-1073
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Country | US
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Telephone | 786-222-1234
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Fax | 786-222-1235
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Provider Business Mailing Address
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Address Line | 2500 NW 80 AVE SUITE 241
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City | MIAMI
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State | FL
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Zip | 33122
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Country | US
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Telephone | 786-222-1234
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Fax | 786-222-1235
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHICHO LOPEZ
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Credential |
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Telephone | 786-222-1234
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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 |
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License Number State | FL
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