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NPI Code Detail

MEDICARE: LANTANA PHARMACY

MEDICARE: LANTANA PHARMACY
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 PharmacyPH23129FL

General Provider Information

NPI Number : 1700139003
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANTANA PHARMACY
Provider Business Mailing Address
First Line : 3206 LANTANA ROAD
Second Line :
City : LANTANA
State : FL
Zip : 33462-2432
Country : US
Telephone Number : 561-964-7614
Fax Number : 561-964-7615
Provider Business Practice Location Address
First Line : 3206 LANTANA ROAD
Second Line :
City : LANTANA
State : FL
Zip : 33462-2432
Country : US
Telephone Number : 561-964-7614
Fax Number : 561-964-7615
Authorized Official
Title or Position : PRESIDENT
Name : MR. CHARLES WILSON
Credential : MBA
Telephone Number : 561-964-7614
Provider Enumeration Date : 10/24/2012
Last Update Date : 10/24/2012

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Directions to “LANTANA PHARMACY ” Practice Location

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