Provider Demographics
NPI:1215207998
Name:PHARMACITY LLC
Entity Type:Organization
Organization Name:PHARMACITY LLC
Other - Org Name:PHARMACITY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-8429
Mailing Address - Street 1:2173 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1638
Mailing Address - Country:US
Mailing Address - Phone:786-360-1820
Mailing Address - Fax:786-360-1795
Practice Address - Street 1:2173 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1638
Practice Address - Country:US
Practice Address - Phone:786-360-1820
Practice Address - Fax:786-360-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH262513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136082OtherPK