Provider Demographics
NPI:1184018756
Name:PHARMACIE PHARMACY INC
Entity Type:Organization
Organization Name:PHARMACIE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-704-3536
Mailing Address - Street 1:13255 SW 137TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5327
Mailing Address - Country:US
Mailing Address - Phone:786-592-1994
Mailing Address - Fax:786-592-1538
Practice Address - Street 1:13255 SW 137TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5327
Practice Address - Country:US
Practice Address - Phone:786-592-1994
Practice Address - Fax:786-592-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH289733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7552840001Medicare NSC