Organization
LA IDEAL PHARMACY & DISCOUNT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS IVAN HERNANDEZ (PRESIDENT)
(305) 821-0070
Entity
Organization
Contact information
Practice address
4920 E 4 AVE, HIALEAH, FL 33012
(305) 821-0070
(305) 821-0071
Mailing address
4920 E 4 AVE, HIALEAH, FL 33012
(305) 821-0070
(305) 821-0071
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH26298
FL
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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