Provider Demographics
NPI:1639182090
Name:GRETA MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:GRETA MEDICAL SERVICES, INC.
Other - Org Name:GRETA MEDICAL & PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ECATHERIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-888-9699
Mailing Address - Street 1:1475 W OKEECHOBEE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2860
Mailing Address - Country:US
Mailing Address - Phone:305-888-9699
Mailing Address - Fax:305-888-9759
Practice Address - Street 1:1475 W OKEECHOBEE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2860
Practice Address - Country:US
Practice Address - Phone:305-888-9699
Practice Address - Fax:305-888-9759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312094332B00000X
FLPH 225733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1312094OtherAHCA LICENSE
FLPH 22573OtherPHARMACY LICENSE
FL1312094OtherAHCA LICENSE