Provider Demographics
NPI:1790970713
Name:NEW LIFE PHARMACY INC
Entity Type:Organization
Organization Name:NEW LIFE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-888-3391
Mailing Address - Street 1:70 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4013
Mailing Address - Country:US
Mailing Address - Phone:305-888-3391
Mailing Address - Fax:305-888-3302
Practice Address - Street 1:70 W 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4013
Practice Address - Country:US
Practice Address - Phone:305-888-3391
Practice Address - Fax:305-888-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH226813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5985100001Medicare NSC