Provider Demographics
NPI:1235560301
Name:SOUTH POINT PHARMACY CORP
Entity Type:Organization
Organization Name:SOUTH POINT PHARMACY CORP
Other - Org Name:SOUTH POINT PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-288-1467
Mailing Address - Street 1:1864 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1915
Mailing Address - Country:US
Mailing Address - Phone:305-541-8699
Mailing Address - Fax:305-541-8696
Practice Address - Street 1:1864 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1915
Practice Address - Country:US
Practice Address - Phone:305-541-8699
Practice Address - Fax:305-541-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH257973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143162OtherPK
FL0267775900Medicaid