Provider Demographics
NPI:1275963456
Name:VERSALLES PHARMACY INC
Entity Type:Organization
Organization Name:VERSALLES PHARMACY INC
Other - Org Name:VERSALLES PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-7333
Mailing Address - Street 1:3526 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1028
Mailing Address - Country:US
Mailing Address - Phone:305-456-7333
Mailing Address - Fax:305-456-3938
Practice Address - Street 1:3526 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1028
Practice Address - Country:US
Practice Address - Phone:305-456-7333
Practice Address - Fax:305-456-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH264633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143175OtherPK