Provider Demographics
NPI:1437454154
Name:GOLDEN OWL PHARMACY & DISCOUNT CORP
Entity Type:Organization
Organization Name:GOLDEN OWL PHARMACY & DISCOUNT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLETY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-263-6646
Mailing Address - Street 1:1874 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2139
Mailing Address - Country:US
Mailing Address - Phone:305-263-6646
Mailing Address - Fax:305-263-6647
Practice Address - Street 1:1874 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2139
Practice Address - Country:US
Practice Address - Phone:305-263-6646
Practice Address - Fax:305-263-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44555OtherDOC NUMBER