Provider Demographics
NPI:1760052252
Name:LUX PHARMACY CORP
Entity Type:Organization
Organization Name:LUX PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YESIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-432-9111
Mailing Address - Street 1:13205 SW 137TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5333
Mailing Address - Country:US
Mailing Address - Phone:786-432-9111
Mailing Address - Fax:786-432-9112
Practice Address - Street 1:13205 SW 137TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5333
Practice Address - Country:US
Practice Address - Phone:786-432-9111
Practice Address - Fax:786-432-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4577OtherNUMB