Provider Demographics
NPI:1205281458
Name:LINCOLN PHARMACY LLC
Entity type:Organization
Organization Name:LINCOLN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-534-9161
Mailing Address - Street 1:21011 JOHNSON ST
Mailing Address - Street 2:SUITE# 126
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1913
Mailing Address - Country:US
Mailing Address - Phone:954-534-9161
Mailing Address - Fax:800-765-2524
Practice Address - Street 1:21011 JOHNSON ST
Practice Address - Street 2:SUITE# 126
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1913
Practice Address - Country:US
Practice Address - Phone:954-534-9161
Practice Address - Fax:800-765-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH298253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy