Provider Demographics
NPI:1114019221
Name:REINOSA ENTERPRICES
Entity Type:Organization
Organization Name:REINOSA ENTERPRICES
Other - Org Name:SEDANOS PHARMACY #28
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUERVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-9582
Mailing Address - Street 1:3140 WEST 76 STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-364-2306
Mailing Address - Fax:305-364-2309
Practice Address - Street 1:3140 WEST 76 STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-364-2306
Practice Address - Fax:305-364-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH00174933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4284780001Medicare ID - Type Unspecified