Provider Demographics
NPI:1164780516
Name:WATED PHARMACY DISCOUNT INC
Entity Type:Organization
Organization Name:WATED PHARMACY DISCOUNT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-271-0131
Mailing Address - Street 1:7130 SW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2809
Mailing Address - Country:US
Mailing Address - Phone:305-271-0131
Mailing Address - Fax:305-271-0131
Practice Address - Street 1:7130 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2809
Practice Address - Country:US
Practice Address - Phone:305-271-0131
Practice Address - Fax:305-271-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3845OtherDOC NUMB