Provider Demographics
NPI:1740579044
Name:EP LTC PHARMACY
Entity Type:Organization
Organization Name:EP LTC PHARMACY
Other - Org Name:EP L.T.C. PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEUTERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-630-9308
Mailing Address - Street 1:6440 SW 117TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2822
Mailing Address - Country:US
Mailing Address - Phone:305-630-9308
Mailing Address - Fax:305-630-3414
Practice Address - Street 1:6440 SW 117TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2822
Practice Address - Country:US
Practice Address - Phone:305-630-9308
Practice Address - Fax:305-630-3414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EP MEDICAL EQUIPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25362332B00000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH25362OtherSTATE PHARMACY LICENSE
FL004178700Medicaid
FL0943870003Medicare NSC