Provider Demographics
NPI:1639253685
Name:SOUTH MIAMI PHARMACY INC
Entity Type:Organization
Organization Name:SOUTH MIAMI PHARMACY INC
Other - Org Name:SOUTH MIAMI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDISA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:305-668-6150
Mailing Address - Street 1:6050 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5042
Mailing Address - Country:US
Mailing Address - Phone:305-740-9696
Mailing Address - Fax:305-740-9778
Practice Address - Street 1:6233 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4804
Practice Address - Country:US
Practice Address - Phone:305-668-6150
Practice Address - Fax:305-668-6137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
FLPH192873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1099452OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL026503900Medicaid
4987180001Medicare NSC