Provider Demographics
NPI:1922377993
Name:NEW LIFE COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:NEW LIFE COMMUNITY PHARMACY
Other - Org Name:NEW LIFE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-4020
Mailing Address - Street 1:3032 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3624
Mailing Address - Country:US
Mailing Address - Phone:786-360-4020
Mailing Address - Fax:786-334-5385
Practice Address - Street 1:3032 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3624
Practice Address - Country:US
Practice Address - Phone:786-360-4020
Practice Address - Fax:786-334-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH271133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708714OtherNCPDP PROVIDER IDENTIFICATION NUMBER