Provider Demographics
NPI:1003125584
Name:TONAIS PHARMACY AND SURGICAL SUPPLY STORE INC
Entity Type:Organization
Organization Name:TONAIS PHARMACY AND SURGICAL SUPPLY STORE INC
Other - Org Name:TONAIS PHARMACY AND SURGICAL SUPPLY STORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-4710
Mailing Address - Street 1:5851 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3316
Mailing Address - Country:US
Mailing Address - Phone:305-261-4710
Mailing Address - Fax:305-261-4720
Practice Address - Street 1:5851 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3316
Practice Address - Country:US
Practice Address - Phone:305-261-4710
Practice Address - Fax:305-261-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH248763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701962OtherNCPDP PROVIDER IDENTIFICATION NUMBER