Provider Demographics
NPI:1679841423
Name:PHARMOVISAMD
Entity Type:Organization
Organization Name:PHARMOVISAMD
Other - Org Name:MORALES DISCOUNT & PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUB-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:786-281-2846
Mailing Address - Street 1:7035 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2505
Mailing Address - Country:US
Mailing Address - Phone:305-274-7772
Mailing Address - Fax:305-274-5463
Practice Address - Street 1:7035 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2505
Practice Address - Country:US
Practice Address - Phone:305-274-7772
Practice Address - Fax:305-274-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 243353336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001976600Medicaid
FL6559280001Medicare NSC