Provider Demographics
NPI:1023363637
Name:ULTRA PHARMACY DISCOUNT INC
Entity Type:Organization
Organization Name:ULTRA PHARMACY DISCOUNT INC
Other - Org Name:ULTRA PHARMACY DISCOUNT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-637-3066
Mailing Address - Street 1:2416 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7234
Mailing Address - Country:US
Mailing Address - Phone:305-637-3066
Mailing Address - Fax:305-637-3068
Practice Address - Street 1:2416 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7234
Practice Address - Country:US
Practice Address - Phone:305-637-3066
Practice Address - Fax:305-637-3068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137864OtherPK