Provider Demographics
NPI:1568083830
Name:MJ PHARMACY & DISCOUNT LLC
Entity Type:Organization
Organization Name:MJ PHARMACY & DISCOUNT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACY
Authorized Official - Phone:786-259-3076
Mailing Address - Street 1:1545 WEST 62ND STREET
Mailing Address - Street 2:SUITE 62
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:786-259-3076
Mailing Address - Fax:786-364-1602
Practice Address - Street 1:1545 WEST 62ND STREET
Practice Address - Street 2:SUITE 62
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:786-259-3076
Practice Address - Fax:786-364-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy