Provider Demographics
NPI:1629316500
Name:CHORI CORP
Entity Type:Organization
Organization Name:CHORI CORP
Other - Org Name:COBRA MEDICAL EQUIPMENT PLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-629-2633
Mailing Address - Street 1:10825 NW 17TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2016
Mailing Address - Country:US
Mailing Address - Phone:305-629-2633
Mailing Address - Fax:305-629-8081
Practice Address - Street 1:10825 NW 17TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2016
Practice Address - Country:US
Practice Address - Phone:305-629-2633
Practice Address - Fax:305-629-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260713336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5713195OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL951866500Medicaid