Provider Demographics
NPI:1225064710
Name:A B PHARMACY INC
Entity Type:Organization
Organization Name:A B PHARMACY INC
Other - Org Name:A B PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-2180
Mailing Address - Street 1:1956 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1615
Mailing Address - Country:US
Mailing Address - Phone:305-649-2180
Mailing Address - Fax:305-649-9672
Practice Address - Street 1:1956 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1615
Practice Address - Country:US
Practice Address - Phone:305-649-2180
Practice Address - Fax:305-649-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH217203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026667100Medicaid
1003350OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5205520001Medicare NSC