Provider Demographics
NPI:1407049943
Name:VISA PHARMACY & DISCOUNT STORE INC
Entity Type:Organization
Organization Name:VISA PHARMACY & DISCOUNT STORE INC
Other - Org Name:SEDANO'S PHARMACY # 3
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-691-7817
Mailing Address - Street 1:1700 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4437
Mailing Address - Country:US
Mailing Address - Phone:305-556-3008
Mailing Address - Fax:786-621-5477
Practice Address - Street 1:10171 NW 129TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1656
Practice Address - Country:US
Practice Address - Phone:305-761-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0008168302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS25456OtherPHARMACIST