Provider Demographics
NPI:1700860020
Name:MIAMI DOWNTOWN PHARMACY, INC
Entity Type:Organization
Organization Name:MIAMI DOWNTOWN PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-374-5076
Mailing Address - Street 1:96 SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4726
Mailing Address - Country:US
Mailing Address - Phone:305-374-5076
Mailing Address - Fax:305-371-9524
Practice Address - Street 1:96 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1008
Practice Address - Country:US
Practice Address - Phone:305-374-5076
Practice Address - Fax:305-371-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21090333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5365950001Medicare ID - Type Unspecified