Provider Demographics
NPI:1861790040
Name:FARMACIA LATINA CORP.
Entity type:Organization
Organization Name:FARMACIA LATINA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLOOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-766-5526
Mailing Address - Street 1:216 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-766-5526
Mailing Address - Fax:201-766-5528
Practice Address - Street 1:216 48TH STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-766-5526
Practice Address - Fax:201-766-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS007109003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRS00710900OtherSTATE PHARMACY LICENSE
NJ6518340001Medicare NSC