Provider Demographics
NPI:1033404173
Name:YANISA PHARMACY INC
Entity Type:Organization
Organization Name:YANISA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:FINALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-554-5210
Mailing Address - Street 1:11200 W FLAGLER ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4210
Mailing Address - Country:US
Mailing Address - Phone:305-554-5210
Mailing Address - Fax:305-554-6820
Practice Address - Street 1:11200 W FLAGLER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4210
Practice Address - Country:US
Practice Address - Phone:305-554-5210
Practice Address - Fax:305-554-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6709110001Medicare NSC