Provider Demographics
NPI:1093880064
Name:LOCATEL SUNNY ISLES LLC
Entity Type:Organization
Organization Name:LOCATEL SUNNY ISLES LLC
Other - Org Name:MIRAMAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ANTONIONI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-392-8000
Mailing Address - Street 1:1951 SW 172ND AVE
Mailing Address - Street 2:SUITE #107
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:954-392-8000
Mailing Address - Fax:954-392-8070
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-392-8000
Practice Address - Fax:954-392-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21641332B00000X
333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016167OtherOTHER ID NUMBER
FL031314900Medicaid
1016167OtherOTHER ID NUMBER