Provider Demographics
NPI:1124198916
Name:IDEAL RX PHARMACY INC
Entity Type:Organization
Organization Name:IDEAL RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:LAFETTE
Authorized Official - Last Name:DYETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-687-4480
Mailing Address - Street 1:823 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168
Mailing Address - Country:US
Mailing Address - Phone:305-687-4480
Mailing Address - Fax:305-687-4464
Practice Address - Street 1:823 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:305-687-4480
Practice Address - Fax:305-687-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH195293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2046720001Medicare ID - Type Unspecified