Provider Demographics
NPI:1033416433
Name:EXCELLENT PHARMACY & DISCOUNT
Entity Type:Organization
Organization Name:EXCELLENT PHARMACY & DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-1465
Mailing Address - Street 1:11400 W FLAGLER ST
Mailing Address - Street 2:109-110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4007
Mailing Address - Country:US
Mailing Address - Phone:305-456-1465
Mailing Address - Fax:
Practice Address - Street 1:11400 W FLAGLER ST
Practice Address - Street 2:109-110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4007
Practice Address - Country:US
Practice Address - Phone:305-456-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH25284OtherBOARD OF PHARMACY