Organization
LAGE PHARMACY INC
Active
Other names
ABC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA MUSTAFA (PRESIDENT)
(305) 649-3333
Entity
Organization
Contact information
Practice address
3485 W FLAGLER ST STE 200, MIAMI, FL 33135-1042
(305) 649-3333
(305) 649-5722
Mailing address
3485 W FLAGLER ST STE 200, MIAMI, FL 33135-1042
(305) 649-3333
(305) 649-5722
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH8887
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025545900
—
FL
05
—
025545901
—
FL
01
—
1037022
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/20/2006
Last updated
03/29/2011
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