Organization
ILVA PHARMACY INC
Active
Other names
ILVA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
JANET DE LA CRUZ (PRESIDENT)
(305) 519-1577
Entity
Organization
Contact information
Practice address
10550 NW 77TH CT, STE 303, HIALEAH GARDENS, FL 33016-7084
(305) 821-8881
(305) 821-8851
Mailing address
10550 NW 77TH CT, STE 303, HIALEAH GARDENS, FL 33016-7084
(305) 821-8881
(305) 821-8851
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032084
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/29/2007
Last updated
06/09/2010
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