Provider Demographics
NPI:1619956273
Name:AGUIMART CORP
Entity Type:Organization
Organization Name:AGUIMART CORP
Other - Org Name:LA ISLA PHARMACY & DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-6244
Mailing Address - Street 1:432 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5729
Mailing Address - Country:US
Mailing Address - Phone:305-863-6244
Mailing Address - Fax:305-863-6245
Practice Address - Street 1:432 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5729
Practice Address - Country:US
Practice Address - Phone:305-863-6244
Practice Address - Fax:305-863-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21627333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1016523OtherNCPDP
FLPH21627OtherPHARMA CY LICENSE