Provider Demographics
NPI:1215014949
Name:SAN MARTIN'S PHARMACY INC
Entity Type:Organization
Organization Name:SAN MARTIN'S PHARMACY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-445-0033
Mailing Address - Street 1:2255 SW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3177
Mailing Address - Country:US
Mailing Address - Phone:305-445-0033
Mailing Address - Fax:305-445-8811
Practice Address - Street 1:2255 SW 32ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3177
Practice Address - Country:US
Practice Address - Phone:305-445-0033
Practice Address - Fax:305-445-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20780183500000X, 3336C0003X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102883900Medicaid
FL1074183OtherNABP #
FL102883901Medicaid
FL102883901Medicaid
FL102883901Medicaid