Provider Demographics
NPI:1003098971
Name:#1 RX LIBERTY PHARMACY DISCOUNT CORP
Entity Type:Organization
Organization Name:#1 RX LIBERTY PHARMACY DISCOUNT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-691-6686
Mailing Address - Street 1:972 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3404
Mailing Address - Country:US
Mailing Address - Phone:305-691-6686
Mailing Address - Fax:305-691-6682
Practice Address - Street 1:972 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3404
Practice Address - Country:US
Practice Address - Phone:305-691-6686
Practice Address - Fax:305-691-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6337430001Medicare NSC