Provider Demographics
NPI:1225493927
Name:ITABO PHARMACY
Entity Type:Organization
Organization Name:ITABO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-916-9174
Mailing Address - Street 1:237 NW 12TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1080
Mailing Address - Country:US
Mailing Address - Phone:305-916-9174
Mailing Address - Fax:305-228-0448
Practice Address - Street 1:237 NW 12TH AVE
Practice Address - Street 2:STE C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1080
Practice Address - Country:US
Practice Address - Phone:305-916-9174
Practice Address - Fax:305-228-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH293973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy