Provider Demographics
NPI:1033281357
Name:AB PHARMACY INC
Entity Type:Organization
Organization Name:AB PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-2180
Mailing Address - Street 1:1956 WEST FLAGEN STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1615
Mailing Address - Country:US
Mailing Address - Phone:305-649-2180
Mailing Address - Fax:305-649-9672
Practice Address - Street 1:1956 WEST FLAGEN STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1615
Practice Address - Country:US
Practice Address - Phone:305-649-2180
Practice Address - Fax:305-649-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21720332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003350OtherNCPDP
PH21720OtherPHARMACY LICENSE
FL02666710Medicaid
PH21720OtherPHARMACY LICENSE