Provider Demographics
NPI:1356626204
Name:PINES PHARMACY INC
Entity Type:Organization
Organization Name:PINES PHARMACY INC
Other - Org Name:PINES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-889-0377
Mailing Address - Street 1:881 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4205
Mailing Address - Country:US
Mailing Address - Phone:305-889-0377
Mailing Address - Fax:305-882-1162
Practice Address - Street 1:881 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4205
Practice Address - Country:US
Practice Address - Phone:305-889-0377
Practice Address - Fax:305-882-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH252803336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5707849OtherNCPDP PROVIDER IDENTIFICATION NUMBER