Organization
PRESTAB CO
Active
Organization
PRESTAB CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALEXIS M. BASULTO (PRESIDENT)
(305) 599-7000
Entity
Organization
Contact information
Practice address
3016 NW 79TH AVE, DORAL, FL 33122-1010
(305) 599-1643
(305) 599-1663
Mailing address
3016 NW 79TH AVE, DORAL, FL 33122-1010
(305) 599-1643
(305) 599-1663
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH19462
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02697010
—
FL
Enumeration date
10/19/2006
Last updated
08/22/2020
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