Provider Demographics
NPI:1720024110
Name:JOSE ANTONIO VILLAMIL-RODRIGUEZ
Entity Type:Organization
Organization Name:JOSE ANTONIO VILLAMIL-RODRIGUEZ
Other - Org Name:LA FARMACIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-621-2005
Mailing Address - Street 1:16000 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6804
Mailing Address - Country:US
Mailing Address - Phone:305-621-2005
Mailing Address - Fax:305-620-0905
Practice Address - Street 1:16000 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6804
Practice Address - Country:US
Practice Address - Phone:305-621-2005
Practice Address - Fax:305-620-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH253143336C0003X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095682OtherNCPDP PROVIDER IDENTIFICATION NUMBER