Provider Demographics
NPI:1083789440
Name:ELY'S PHARMACY AND DISCOUNT CORP.
Entity Type:Organization
Organization Name:ELY'S PHARMACY AND DISCOUNT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMACIST MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-385-7770
Mailing Address - Street 1:15126 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4072
Mailing Address - Country:US
Mailing Address - Phone:305-385-7770
Mailing Address - Fax:
Practice Address - Street 1:15126 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4072
Practice Address - Country:US
Practice Address - Phone:305-385-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH211853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FL5431530001Medicare ID - Type Unspecified