Provider Demographics
NPI:1699191296
Name:LA BOTICA PHARMACY INC
Entity Type:Organization
Organization Name:LA BOTICA PHARMACY INC
Other - Org Name:LA BOTICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-703-4284
Mailing Address - Street 1:10550 NW 77TH CT STE 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2069
Mailing Address - Country:US
Mailing Address - Phone:786-703-4284
Mailing Address - Fax:786-703-7767
Practice Address - Street 1:10550 NW 77TH CT STE 109
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2069
Practice Address - Country:US
Practice Address - Phone:786-703-4284
Practice Address - Fax:786-703-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH275703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144549OtherPK