Provider Demographics
NPI:1598017089
Name:PG OF MIAMI LLC
Entity Type:Organization
Organization Name:PG OF MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUNR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-585-9234
Mailing Address - Street 1:880 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5743
Mailing Address - Country:US
Mailing Address - Phone:305-893-1122
Mailing Address - Fax:
Practice Address - Street 1:880 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5743
Practice Address - Country:US
Practice Address - Phone:305-893-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy