Organization
VITAL LIFE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE BALAREZO PHARMD (OWNER)
(954) 871-7633
Entity
Organization
Contact information
Practice address
6063 SW 18TH ST, BAY 112, BOCA RATON, FL 33433-7118
(561) 245-7082
Mailing address
6063 SW 18TH ST, BAY 112, BOCA RATON, FL 33433-7118
(561) 245-7082
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH28149
FL
Other
Enumeration date
05/15/2014
Last updated
05/15/2014
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