Provider Demographics
NPI:1467472704
Name:BAXTER PHARMACY & DISCOUNT
Entity Type:Organization
Organization Name:BAXTER PHARMACY & DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-408-7290
Mailing Address - Street 1:13730 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4000
Mailing Address - Country:US
Mailing Address - Phone:305-408-7290
Mailing Address - Fax:305-408-7289
Practice Address - Street 1:13730 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4000
Practice Address - Country:US
Practice Address - Phone:305-408-7290
Practice Address - Fax:305-408-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21401332B00000X, 3336C0003X
FL030949401332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030949400Medicaid
FL030949401Medicaid
FL030949401Medicaid