Provider Demographics
NPI:1053681585
Name:CC PHARMACY DISCOUNT & SUPPLY CORP
Entity Type:Organization
Organization Name:CC PHARMACY DISCOUNT & SUPPLY CORP
Other - Org Name:CC PHARMACY DISCOUNT & SUPPLY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-6690
Mailing Address - Street 1:10550 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2612
Mailing Address - Country:US
Mailing Address - Phone:305-552-6690
Mailing Address - Fax:305-552-6689
Practice Address - Street 1:10550 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2612
Practice Address - Country:US
Practice Address - Phone:305-552-6690
Practice Address - Fax:305-552-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH258013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708562OtherNCPDP PROVIDER IDENTIFICATION NUMBER