Provider Demographics
NPI:1366867566
Name:PINO PHARMACY CORP.
Entity Type:Organization
Organization Name:PINO PHARMACY CORP.
Other - Org Name:PINO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-2920
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-262-2920
Mailing Address - Fax:305-262-2921
Practice Address - Street 1:1350 SW 57TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5700
Practice Address - Country:US
Practice Address - Phone:305-262-2920
Practice Address - Fax:305-262-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH275143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144345OtherPK
FL014308700Medicaid