Provider Demographics
NPI:1548572092
Name:NMB GENERICS PHARMACY
Entity Type:Organization
Organization Name:NMB GENERICS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-974-4510
Mailing Address - Street 1:16600 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6026
Mailing Address - Country:US
Mailing Address - Phone:305-974-4510
Mailing Address - Fax:305-454-9748
Practice Address - Street 1:16600 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6026
Practice Address - Country:US
Practice Address - Phone:305-974-4510
Practice Address - Fax:305-454-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24730332B00000X, 3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003506400Medicaid