Provider Demographics
NPI:1629410089
Name:305 PHARMACY INC
Entity Type:Organization
Organization Name:305 PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-7766
Mailing Address - Street 1:11398 W FLAGLER ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4213
Mailing Address - Country:US
Mailing Address - Phone:305-228-7766
Mailing Address - Fax:305-228-7755
Practice Address - Street 1:11398 W FLAGLER ST
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4213
Practice Address - Country:US
Practice Address - Phone:305-228-7766
Practice Address - Fax:305-228-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH270583336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy