Provider Demographics
NPI:1114291705
Name:RED PHARMACY LLC
Entity Type:Organization
Organization Name:RED PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-477-6502
Mailing Address - Street 1:350 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3031
Mailing Address - Country:US
Mailing Address - Phone:305-477-6502
Mailing Address - Fax:305-477-6518
Practice Address - Street 1:350 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3031
Practice Address - Country:US
Practice Address - Phone:305-477-6502
Practice Address - Fax:305-477-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4494OtherDOC NUMB