Provider Demographics
NPI:1194863944
Name:PUMAR PHARMACY INC
Entity Type:Organization
Organization Name:PUMAR PHARMACY INC
Other - Org Name:SWEETWATER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:NEGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-4177
Mailing Address - Street 1:528 SW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1336
Mailing Address - Country:US
Mailing Address - Phone:305-552-0166
Mailing Address - Fax:305-552-0168
Practice Address - Street 1:528 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1336
Practice Address - Country:US
Practice Address - Phone:305-552-0166
Practice Address - Fax:305-552-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH89653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1022007OtherOTHER ID NUMBER
FL101518400Medicaid