Provider Demographics
NPI:1043526965
Name:LUCKY PHARMS INC
Entity type:Organization
Organization Name:LUCKY PHARMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-762-5521
Mailing Address - Street 1:375 NE 54TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2967
Mailing Address - Country:US
Mailing Address - Phone:305-762-5521
Mailing Address - Fax:305-433-4113
Practice Address - Street 1:375 NE 54TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2967
Practice Address - Country:US
Practice Address - Phone:305-762-5521
Practice Address - Fax:305-433-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24825333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701619OtherNCPDP PROVIDER IDENTIFICATION NUMBER