Provider Demographics
NPI:1407877459
Name:NOBIS PHARMACY
Entity Type:Organization
Organization Name:NOBIS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZUNOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-652-9600
Mailing Address - Street 1:PO BOX 170332
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33017-0332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6017
Practice Address - Country:US
Practice Address - Phone:305-652-9600
Practice Address - Fax:305-652-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH133773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1075337OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0967220001Medicare ID - Type Unspecified