Provider Demographics
NPI:1346274297
Name:LOS PALACIOS MEDICAL SUPPLIES & PHARMACY
Entity Type:Organization
Organization Name:LOS PALACIOS MEDICAL SUPPLIES & PHARMACY
Other - Org Name:LOS PALACIOS MEDICAL SUPPLIES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:786-301-6803
Mailing Address - Street 1:4213 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2305
Mailing Address - Country:US
Mailing Address - Phone:305-688-0644
Mailing Address - Fax:305-688-0662
Practice Address - Street 1:4213 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2305
Practice Address - Country:US
Practice Address - Phone:305-688-0644
Practice Address - Fax:305-688-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH233043336C0003X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011367OtherPK
FL117627900Medicaid
FL008158300Medicaid