Provider Demographics
NPI:1366197436
Name:CONFIDENTIAL PHARMA
Entity type:Organization
Organization Name:CONFIDENTIAL PHARMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-467-4868
Mailing Address - Street 1:645 W HALLANDALE BEACH BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5345
Mailing Address - Country:US
Mailing Address - Phone:305-570-1933
Mailing Address - Fax:305-570-2433
Practice Address - Street 1:645 W HALLANDALE BEACH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5345
Practice Address - Country:US
Practice Address - Phone:305-570-1933
Practice Address - Fax:305-570-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy