Provider Demographics
NPI:1376038554
Name:REAL PHARMACY INC
Entity Type:Organization
Organization Name:REAL PHARMACY INC
Other - Org Name:REAL PHARMACY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANNIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-534-5952
Mailing Address - Street 1:455 SW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3626
Mailing Address - Country:US
Mailing Address - Phone:786-534-5952
Mailing Address - Fax:786-534-7818
Practice Address - Street 1:455 SW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3626
Practice Address - Country:US
Practice Address - Phone:786-534-5952
Practice Address - Fax:786-534-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH315103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31510OtherSTATE LICENSE