Provider Demographics
NPI:1043614217
Name:STAYWELL RX PHARMACY LLC
Entity Type:Organization
Organization Name:STAYWELL RX PHARMACY LLC
Other - Org Name:STAYWELL RX PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMARILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTOPINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-8297
Mailing Address - Street 1:7209 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1401
Mailing Address - Country:US
Mailing Address - Phone:305-262-8297
Mailing Address - Fax:305-262-8299
Practice Address - Street 1:7209 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1401
Practice Address - Country:US
Practice Address - Phone:305-262-8297
Practice Address - Fax:305-262-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH286343336C0003X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148661OtherPK