Provider Demographics
NPI:1437148830
Name:VACRUZ INC
Entity Type:Organization
Organization Name:VACRUZ INC
Other - Org Name:A. CRUZ FUENTES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-836-9964
Mailing Address - Street 1:3305 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3005
Mailing Address - Country:US
Mailing Address - Phone:305-836-9964
Mailing Address - Fax:305-836-2050
Practice Address - Street 1:3305 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3005
Practice Address - Country:US
Practice Address - Phone:305-836-9964
Practice Address - Fax:305-836-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH3009333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1145290001Medicare ID - Type Unspecified