Provider Demographics
NPI:1700869880
Name:MAZAL TOV PHARMACY INC
Entity Type:Organization
Organization Name:MAZAL TOV PHARMACY INC
Other - Org Name:MAZALTOVPHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEXY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-269-1672
Mailing Address - Street 1:5582 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1066
Mailing Address - Country:US
Mailing Address - Phone:305-269-1672
Mailing Address - Fax:305-269-9799
Practice Address - Street 1:5582 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1066
Practice Address - Country:US
Practice Address - Phone:305-269-1672
Practice Address - Fax:305-269-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH182223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1094945OtherNCPDP PROVIDER IDENTIFICATION NUMBER