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NPI Code Detail

MEDICARE: ECLIPSE PHARMACY CORP

MEDICARE: ECLIPSE PHARMACY CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12617OTHERFLDRUG STORE

General Provider Information

NPI Number : 1194297382
Entity Type Code : Organization
Provider Name (Legal Business Name) : ECLIPSE PHARMACY CORP
Provider Business Mailing Address
First Line : 3498 NW 7TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33125-4014
Country : US
Telephone Number : 305-381-5752
Fax Number : 305-381-5525
Provider Business Practice Location Address
First Line : 3498 NW 7TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33125-4014
Country : US
Telephone Number : 305-381-5752
Fax Number : 305-381-5525
Authorized Official
Title or Position : PRESIDENT
Name : ARMANDO DE LA NOVAL
Credential :
Telephone Number : 305-381-5752
Provider Enumeration Date : 12/28/2018
Last Update Date : 06/05/2020

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Directions to “ECLIPSE PHARMACY CORP ” Practice Location

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