Provider Demographics
NPI:1235530023
Name:MED BLUE PHARMACY & DISCOUNT INC
Entity Type:Organization
Organization Name:MED BLUE PHARMACY & DISCOUNT INC
Other - Org Name:MED BLUE PHARMACY & DISCOUNT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YARIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-2686
Mailing Address - Street 1:1850 SW 8TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3433
Mailing Address - Country:US
Mailing Address - Phone:786-534-2686
Mailing Address - Fax:786-534-2687
Practice Address - Street 1:1850 SW 8TH ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3434
Practice Address - Country:US
Practice Address - Phone:786-534-2686
Practice Address - Fax:786-534-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH285253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147769OtherPK