Provider Demographics
NPI:1023382512
Name:SPEED II PHAMACY
Entity Type:Organization
Organization Name:SPEED II PHAMACY
Other - Org Name:SPEED II PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-325-2551
Mailing Address - Street 1:2900 W 12TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4861
Mailing Address - Country:US
Mailing Address - Phone:786-310-7845
Mailing Address - Fax:786-310-7851
Practice Address - Street 1:2900 W 12TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4861
Practice Address - Country:US
Practice Address - Phone:786-310-7845
Practice Address - Fax:786-310-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH260493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5710086OtherNCPDP PROVIDER IDENTIFICATION NUMBER