Provider Demographics
NPI:1346355468
Name:NAVARRO DISCOUNT PHARMACIES 16 LLC
Entity Type:Organization
Organization Name:NAVARRO DISCOUNT PHARMACIES 16 LLC
Other - Org Name:NAVARRO DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RX MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-636-7779
Mailing Address - Street 1:9400 NW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1333
Mailing Address - Country:US
Mailing Address - Phone:305-636-7779
Mailing Address - Fax:
Practice Address - Street 1:9720 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1943
Practice Address - Country:US
Practice Address - Phone:305-636-7779
Practice Address - Fax:305-598-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL031870101332B00000X
FLPH0018219333600000X
FL4542590001333600000X
FL031870100333600000X
FL1094212333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031870100Medicaid
FL1094212OtherNCPDP
FL031870101Medicaid
FL4542590001Medicare NSC