Provider Demographics
NPI:1467862540
Name:NUESTRA PHARMACY AND DISCOUNT, CORP.
Entity Type:Organization
Organization Name:NUESTRA PHARMACY AND DISCOUNT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-418-0052
Mailing Address - Street 1:1208 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2404
Mailing Address - Country:US
Mailing Address - Phone:305-418-0052
Mailing Address - Fax:786-420-2881
Practice Address - Street 1:1208 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2404
Practice Address - Country:US
Practice Address - Phone:305-418-0052
Practice Address - Fax:786-420-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH280853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy