Provider Demographics
NPI:1467687632
Name:FLORIDA PHARMACY NO 2 INC
Entity Type:Organization
Organization Name:FLORIDA PHARMACY NO 2 INC
Other - Org Name:FLORIDA PHARMACY # 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-620-1333
Mailing Address - Street 1:4633 NW 199TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1508
Mailing Address - Country:US
Mailing Address - Phone:305-620-1333
Mailing Address - Fax:305-625-8915
Practice Address - Street 1:4633 NW 199TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1508
Practice Address - Country:US
Practice Address - Phone:305-620-1333
Practice Address - Fax:305-625-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH253543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130161OtherPK