Provider Demographics
NPI:1487640827
Name:ASIS PHARMACY. INC. ASIS PHARMACY
Entity Type:Organization
Organization Name:ASIS PHARMACY. INC. ASIS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-2430
Mailing Address - Street 1:1061 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4614
Mailing Address - Country:US
Mailing Address - Phone:305-642-2430
Mailing Address - Fax:305-642-2432
Practice Address - Street 1:1061 SW 27TH AVE.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2442
Practice Address - Country:US
Practice Address - Phone:305-642-2430
Practice Address - Fax:305-642-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH6186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104096100Medicaid
FLPH6186OtherPHARMACY LICENSE
FLPH6186OtherPHARMACY LICENSE