Provider Demographics
NPI:1114359072
Name:BIRD ROAD PHARMACY & DISCOUNT INC
Entity Type:Organization
Organization Name:BIRD ROAD PHARMACY & DISCOUNT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-264-0608
Mailing Address - Street 1:7951 SW 40TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6752
Mailing Address - Country:US
Mailing Address - Phone:305-264-0608
Mailing Address - Fax:305-261-0807
Practice Address - Street 1:7951 SW 40TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6752
Practice Address - Country:US
Practice Address - Phone:305-264-0608
Practice Address - Fax:305-261-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH26970333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy