Provider Demographics
NPI:1144402421
Name:GOODLIFE PHARMACY INC
Entity Type:Organization
Organization Name:GOODLIFE PHARMACY INC
Other - Org Name:GOODLIFE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-999-8855
Mailing Address - Street 1:8903 GLADES RD
Mailing Address - Street 2:STE G13
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4074
Mailing Address - Country:US
Mailing Address - Phone:561-999-8855
Mailing Address - Fax:561-999-8855
Practice Address - Street 1:104 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3908
Practice Address - Country:US
Practice Address - Phone:561-999-8855
Practice Address - Fax:561-948-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH230793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1030458OtherNCPDP PROVIDER IDENTIFICATION NUMBER