Organization
NORTHLAKE PHARMACY LLC
Active
Other names
Northlake Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SALIM SOUFAN RPH (OWNER/PHARMACIST/AO)
(561) 562-2610
Entity
Organization
Contact information
Practice address
9091 N MILITARY TRL STE 17, PALM BEACH GARDENS, FL 33410-5983
(561) 619-9900
(561) 619-9902
Mailing address
9091 N MILITARY TRL STE 17, PALM BEACH GARDENS, FL 33410-5983
(561) 619-9900
(561) 619-9902
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH30206
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018799700
—
FL
01
—
2160865
PK
—
Enumeration date
06/29/2016
Last updated
03/14/2017
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