Provider Demographics
NPI:1659624534
Name:MEDPLUS PHARMACY
Entity Type:Organization
Organization Name:MEDPLUS PHARMACY
Other - Org Name:NEW LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORGESANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-8916
Mailing Address - Street 1:13016 SW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4526
Mailing Address - Country:US
Mailing Address - Phone:305-969-4435
Mailing Address - Fax:305-969-4437
Practice Address - Street 1:13016 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4526
Practice Address - Country:US
Practice Address - Phone:305-969-4435
Practice Address - Fax:305-969-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH263653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy