Provider Demographics
NPI:1265664080
Name:LA PERLA PHARMACY,INC
Entity Type:Organization
Organization Name:LA PERLA PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-8419
Mailing Address - Street 1:11180 W FLAGLER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1250
Mailing Address - Country:US
Mailing Address - Phone:305-551-8419
Mailing Address - Fax:305-551-8420
Practice Address - Street 1:11180 W FLAGLER ST STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1250
Practice Address - Country:US
Practice Address - Phone:305-551-8419
Practice Address - Fax:305-551-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH242003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy