Provider Demographics
NPI:1407123854
Name:CTM PHARMACY INC
Entity Type:Organization
Organization Name:CTM PHARMACY INC
Other - Org Name:CTM PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAHARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-252-2056
Mailing Address - Street 1:18901 SW 106TH AVE STE 143
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7663
Mailing Address - Country:US
Mailing Address - Phone:305-252-2056
Mailing Address - Fax:305-252-2057
Practice Address - Street 1:18901 SW 106TH AVE STE 143
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7663
Practice Address - Country:US
Practice Address - Phone:305-252-2056
Practice Address - Fax:305-252-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25788333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132812OtherPK