Provider Demographics
NPI:1619219565
Name:PHARMCO 780 INC
Entity Type:Organization
Organization Name:PHARMCO 780 INC
Other - Org Name:PHARMCO 780 INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-919-7399
Mailing Address - Street 1:1111 PARK CENTRE BLVD
Mailing Address - Street 2:#207
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5365
Mailing Address - Country:US
Mailing Address - Phone:786-657-2060
Mailing Address - Fax:786-955-6619
Practice Address - Street 1:780 FISHERMAN ST # 103
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3806
Practice Address - Country:US
Practice Address - Phone:786-657-2060
Practice Address - Fax:786-955-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH267393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5713828OtherNCPDP PROVIDER IDENTIFICATION NUMBER