Provider Demographics
NPI:1578229084
Name:SCC PHARMACY LLC
Entity Type:Organization
Organization Name:SCC PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GRETEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-392-1027
Mailing Address - Street 1:4950 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2400
Mailing Address - Country:US
Mailing Address - Phone:305-392-1027
Mailing Address - Fax:305-392-1933
Practice Address - Street 1:4950 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2400
Practice Address - Country:US
Practice Address - Phone:305-392-1027
Practice Address - Fax:305-392-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy