Provider Demographics
NPI:1538305479
Name:PERDOMOS PHARMACY & DISCOUNT INC
Entity Type:Organization
Organization Name:PERDOMOS PHARMACY & DISCOUNT INC
Other - Org Name:PERDOMO'S PHARMACY & DISCOUNT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALO PERDOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-818-1971
Mailing Address - Street 1:4286A PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4454
Mailing Address - Country:US
Mailing Address - Phone:305-818-1971
Mailing Address - Fax:305-818-1902
Practice Address - Street 1:4286A PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4454
Practice Address - Country:US
Practice Address - Phone:305-818-1971
Practice Address - Fax:305-818-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH239243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043380OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1043380OtherNCPDP PROVIDER IDENTIFICATION NUMBER