Provider Demographics
NPI:1376898015
Name:GREY DOG III, INC
Entity Type:Organization
Organization Name:GREY DOG III, INC
Other - Org Name:JERRY'S WEST KENDALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-412-6707
Mailing Address - Street 1:15955 SW 96TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1271
Mailing Address - Country:US
Mailing Address - Phone:305-752-0080
Mailing Address - Fax:305-752-0065
Practice Address - Street 1:15955 SW 96TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1271
Practice Address - Country:US
Practice Address - Phone:305-752-0080
Practice Address - Fax:305-752-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH262013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy