Provider Demographics
NPI:1710276803
Name:JALVAREZ PHARMACY INC
Entity Type:Organization
Organization Name:JALVAREZ PHARMACY INC
Other - Org Name:JALVAREZ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-897-3699
Mailing Address - Street 1:483 NW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5682
Mailing Address - Country:US
Mailing Address - Phone:305-265-3755
Mailing Address - Fax:305-647-6100
Practice Address - Street 1:483 NW 42ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5682
Practice Address - Country:US
Practice Address - Phone:305-265-3755
Practice Address - Fax:305-647-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH253493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132964OtherPK