Organization
LIFE PHARMA CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE L HERNANDEZ LARA (PRESIDENT)
(305) 646-1111
Entity
Organization
Contact information
Practice address
1109 NW 22ND AVE, MIAMI, FL 33125
(305) 646-1111
(786) 703-1242
Mailing address
1109 NW 22ND AVE, MIAMI, FL 33125
(305) 646-1111
(786) 703-1242
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NUMBER
3888
FL
Enumeration date
09/09/2022
Last updated
12/09/2022
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