Provider Demographics
NPI:1285021675
Name:MAGNO PHARMACY INC
Entity Type:Organization
Organization Name:MAGNO PHARMACY INC
Other - Org Name:MAGNO PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-502-4399
Mailing Address - Street 1:1609 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1827
Mailing Address - Country:US
Mailing Address - Phone:786-502-4399
Mailing Address - Fax:786-502-4666
Practice Address - Street 1:1609 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1827
Practice Address - Country:US
Practice Address - Phone:786-502-4399
Practice Address - Fax:786-502-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH290563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151639OtherPK
FL7492160001Medicare NSC