Provider Demographics
NPI:1023379534
Name:NIIMERLEY CORPORATION
Entity Type:Organization
Organization Name:NIIMERLEY CORPORATION
Other - Org Name:JLH PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUD-HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-2202
Mailing Address - Street 1:8040 NW 95TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2360
Mailing Address - Country:US
Mailing Address - Phone:305-827-2202
Mailing Address - Fax:305-827-2332
Practice Address - Street 1:8040 NW 95TH ST APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2360
Practice Address - Country:US
Practice Address - Phone:305-827-2202
Practice Address - Fax:305-827-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5710517OtherNCPDP PROVIDER IDENTIFICATION NUMBER