Provider Demographics
NPI:1255927760
Name:THE HOLISTIC APOTHECARY
Entity type:Organization
Organization Name:THE HOLISTIC APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-1040
Mailing Address - Street 1:30 SW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1071
Mailing Address - Country:US
Mailing Address - Phone:786-306-1040
Mailing Address - Fax:
Practice Address - Street 1:1710 NW 7TH ST STE 9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3520
Practice Address - Country:US
Practice Address - Phone:786-353-2490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy