Provider Demographics
NPI:1275516973
Name:FIGUEROA PHARMACY
Entity Type:Organization
Organization Name:FIGUEROA PHARMACY
Other - Org Name:COUNTRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AYMED
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-254-0454
Mailing Address - Street 1:14449 COUNTRY WALK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14449 COUNTRY WALK DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8104
Practice Address - Country:US
Practice Address - Phone:305-254-0454
Practice Address - Fax:305-254-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH215093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014810OtherOTHER ID NUMBER
5513230001Medicare NSC