Provider Demographics
NPI:1659649887
Name:LAS MERCEDES PHARMACY , INC
Entity Type:Organization
Organization Name:LAS MERCEDES PHARMACY , INC
Other - Org Name:LAS MERCEDES PHARMACY , INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:786-401-7301
Mailing Address - Street 1:75 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2613
Mailing Address - Country:US
Mailing Address - Phone:786-401-7301
Mailing Address - Fax:786-431-5975
Practice Address - Street 1:75 W 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2613
Practice Address - Country:US
Practice Address - Phone:786-401-7301
Practice Address - Fax:786-431-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH257633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132745OtherPK