Provider Demographics
NPI:1154628097
Name:MIAMI EXECUTIVE PHARMACY INC
Entity Type:Organization
Organization Name:MIAMI EXECUTIVE PHARMACY INC
Other - Org Name:MIAMI EXECUTIVE PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOVYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-670-5253
Mailing Address - Street 1:8950 SW 74TH CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3171
Mailing Address - Country:US
Mailing Address - Phone:305-670-5253
Mailing Address - Fax:800-557-0966
Practice Address - Street 1:8950 SW 74TH CT STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3172
Practice Address - Country:US
Practice Address - Phone:305-670-5253
Practice Address - Fax:800-557-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
FLPH252413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128860OtherPK
6609120001Medicare NSC