Provider Demographics
NPI:1336475847
Name:SPECIALTY PHARMACY & DISCOUNT CORP
Entity Type:Organization
Organization Name:SPECIALTY PHARMACY & DISCOUNT CORP
Other - Org Name:SPECIALTY PHARMACY & DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-0300
Mailing Address - Street 1:4501 PALM AVE
Mailing Address - Street 2:SUITE#101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4010
Mailing Address - Country:US
Mailing Address - Phone:305-698-0300
Mailing Address - Fax:305-698-0302
Practice Address - Street 1:4501 PALM AVE STE 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4075
Practice Address - Country:US
Practice Address - Phone:305-698-0300
Practice Address - Fax:305-698-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24297333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1049522OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6394610001Medicare NSC