Provider Demographics
NPI:1073112116
Name:HL72 LLC
Entity type:Organization
Organization Name:HL72 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH MGR
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUZEID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:973-479-8032
Mailing Address - Street 1:5618 NECTAR CV
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4085
Mailing Address - Country:US
Mailing Address - Phone:973-479-8032
Mailing Address - Fax:
Practice Address - Street 1:5193 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3213
Practice Address - Country:US
Practice Address - Phone:973-479-8032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32967OtherBOARD OF PHARMACY