Provider Demographics
NPI:1306001953
Name:ABRANTCARE PHARMACY, CORP.
Entity Type:Organization
Organization Name:ABRANTCARE PHARMACY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRECHET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-751-0021
Mailing Address - Street 1:777 NE 79TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4701
Mailing Address - Country:US
Mailing Address - Phone:305-751-0021
Mailing Address - Fax:305-751-0018
Practice Address - Street 1:777 NE 79TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4701
Practice Address - Country:US
Practice Address - Phone:305-751-0021
Practice Address - Fax:305-751-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH235073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6136170001Medicare NSC