Provider Demographics
NPI:1710307160
Name:48TH PHARMACY INC
Entity Type:Organization
Organization Name:48TH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-5491
Mailing Address - Street 1:4800 W FLAGLER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1446
Mailing Address - Country:US
Mailing Address - Phone:305-456-5491
Mailing Address - Fax:786-431-1071
Practice Address - Street 1:4800 W FLAGLER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1446
Practice Address - Country:US
Practice Address - Phone:305-446-7505
Practice Address - Fax:305-446-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy