Provider Demographics
NPI:1417527771
Name:IA SUPPLY PHARMACY CORP
Entity Type:Organization
Organization Name:IA SUPPLY PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMENTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-953-8021
Mailing Address - Street 1:6903 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2846
Mailing Address - Country:US
Mailing Address - Phone:786-953-8021
Mailing Address - Fax:786-536-9022
Practice Address - Street 1:6903 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2846
Practice Address - Country:US
Practice Address - Phone:786-953-8021
Practice Address - Fax:786-536-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy