Provider Demographics
NPI:1073919718
Name:SAN JUDAS PHARMACY CORP
Entity Type:Organization
Organization Name:SAN JUDAS PHARMACY CORP
Other - Org Name:SAN JUDAS PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PURO
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-7145
Mailing Address - Street 1:2604 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5703
Mailing Address - Country:US
Mailing Address - Phone:305-603-7145
Mailing Address - Fax:786-518-3496
Practice Address - Street 1:2604 W 84TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5703
Practice Address - Country:US
Practice Address - Phone:305-603-7145
Practice Address - Fax:786-518-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH286993336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147350OtherPK