Provider Demographics
NPI:1295193324
Name:MN PHARMACY LLC
Entity Type:Organization
Organization Name:MN PHARMACY LLC
Other - Org Name:AMAZON PHARMACY #003
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-745-5725
Mailing Address - Street 1:6701 NW 7TH STREET
Mailing Address - Street 2:SUITE 199
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6008
Mailing Address - Country:US
Mailing Address - Phone:305-907-7947
Mailing Address - Fax:305-908-8571
Practice Address - Street 1:6701 NW 7TH STREET
Practice Address - Street 2:SUITE 199
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-6008
Practice Address - Country:US
Practice Address - Phone:305-907-7947
Practice Address - Fax:305-908-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH298383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157856OtherPK