Provider Demographics
NPI:1215179791
Name:IDEAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:IDEAL PHARMACY SERVICES LLC
Other - Org Name:IDEAL PHARMACY SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-294-0472
Mailing Address - Street 1:4603 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2308
Mailing Address - Country:US
Mailing Address - Phone:786-294-0472
Mailing Address - Fax:786-294-0572
Practice Address - Street 1:4603 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2308
Practice Address - Country:US
Practice Address - Phone:786-294-0472
Practice Address - Fax:786-294-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH 244253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002767500Medicaid
2119921OtherPK