Provider Demographics
NPI:1558619759
Name:YONG PHARMACY DISCOUNT
Entity Type:Organization
Organization Name:YONG PHARMACY DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-388-4990
Mailing Address - Street 1:2324 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1846
Mailing Address - Country:US
Mailing Address - Phone:786-388-4990
Mailing Address - Fax:786-388-7706
Practice Address - Street 1:2324 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1846
Practice Address - Country:US
Practice Address - Phone:786-388-4990
Practice Address - Fax:786-388-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031073500Medicaid