Provider Demographics
NPI:1316378771
Name:VALLEJOS PHARMACY CORP.
Entity Type:Organization
Organization Name:VALLEJOS PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:CHAVEZ
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-552-0007
Mailing Address - Street 1:PO BOX 261394
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-0025
Mailing Address - Country:US
Mailing Address - Phone:786-552-0007
Mailing Address - Fax:786-552-0008
Practice Address - Street 1:4750 NW 7TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2253
Practice Address - Country:US
Practice Address - Phone:786-552-0007
Practice Address - Fax:786-552-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy