Provider Demographics
NPI:1063477784
Name:LATIN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:LATIN MEDICAL SUPPLY INC
Other - Org Name:DBA/ LATIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-885-4214
Mailing Address - Street 1:240 E 1ST AVE
Mailing Address - Street 2:STE 124
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4963
Mailing Address - Country:US
Mailing Address - Phone:305-885-4214
Mailing Address - Fax:305-885-4215
Practice Address - Street 1:240 E 1ST AVE
Practice Address - Street 2:STE 124
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4963
Practice Address - Country:US
Practice Address - Phone:305-885-4214
Practice Address - Fax:305-885-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BX2000X
FLPH228963336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1029645OtherNCPDP DME NUMBER
FL000925000Medicaid
FLPH22895OtherPHARMACY LLICENSE
FLPH22895OtherPHARMACY LLICENSE
FLPH22895OtherPHARMACY LLICENSE