Provider Demographics
NPI:1700593670
Name:HOLISTIC APOTHECARY
Entity Type:Organization
Organization Name:HOLISTIC APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:MARCELINO
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-353-2490
Mailing Address - Street 1:1710 NW 7TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3520
Mailing Address - Country:US
Mailing Address - Phone:786-353-2490
Mailing Address - Fax:
Practice Address - Street 1:1710 NW 7TH ST STE 8
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:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3515OtherNUMB