Provider Demographics
NPI:1427000595
Name:MERY PHARAMACY CORP.
Entity Type:Organization
Organization Name:MERY PHARAMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (PRESIDENT)
Authorized Official - Prefix:
Authorized Official - First Name:IGNELIA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-715-7855
Mailing Address - Street 1:347 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1856
Mailing Address - Country:US
Mailing Address - Phone:305-698-9236
Mailing Address - Fax:305-698-9239
Practice Address - Street 1:347 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1856
Practice Address - Country:US
Practice Address - Phone:305-698-9236
Practice Address - Fax:305-698-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032269500Medicaid
FL5613230001Medicare NSC