Provider Demographics
NPI:1689440810
Name:MY SUPER PHARMACY
Entity Type:Organization
Organization Name:MY SUPER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-485-4170
Mailing Address - Street 1:8601 NW SOUTH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7428
Mailing Address - Country:US
Mailing Address - Phone:786-485-4170
Mailing Address - Fax:786-485-4845
Practice Address - Street 1:8601 NW SOUTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7428
Practice Address - Country:US
Practice Address - Phone:786-485-4170
Practice Address - Fax:786-485-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy