Provider Demographics
NPI:1124024963
Name:MY PHARMACY, INC.
Entity Type:Organization
Organization Name:MY PHARMACY, INC.
Other - Org Name:MY PHARMACY OF CORAL REEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-238-2474
Mailing Address - Street 1:15043 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7930
Mailing Address - Country:US
Mailing Address - Phone:305-238-2474
Mailing Address - Fax:305-238-0261
Practice Address - Street 1:15043 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7930
Practice Address - Country:US
Practice Address - Phone:305-238-2474
Practice Address - Fax:305-238-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 332BX2000X, 335E00000X
FLPH 1823333600000X
FLPH 19817333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP3228OtherBCBS PROVIDER
FL1015874OtherNABP
FLP3228OtherBCBS PROVIDER