Organization
ULTIMA RX LLC
Active
Other names
Ultima Rx
Organization subpart
No
Provider details
NPI number
Authorized official
LEO CUERVO RPH (PRESIDENT)
(305) 557-9512
Entity
Organization
Contact information
Practice address
3900 NW 79TH AVENUE, SUITE 216, DORAL, FL 33166
(305) 557-9512
(305) 552-9291
Mailing address
3900 NW 79TH AVENUE, SUITE 216, DORAL, FL 33166
(305) 557-9512
(305) 552-9291
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH0019526
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004621900
—
FL
Enumeration date
09/28/2006
Last updated
10/03/2012
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