Provider Demographics
NPI:1730457664
Name:PEDMAR PHARMACY AND DISCOUNT
Entity Type:Organization
Organization Name:PEDMAR PHARMACY AND DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-836-3376
Mailing Address - Street 1:922 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3404
Mailing Address - Country:US
Mailing Address - Phone:305-836-3376
Mailing Address - Fax:305-836-5046
Practice Address - Street 1:922 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3404
Practice Address - Country:US
Practice Address - Phone:305-836-3376
Practice Address - Fax:305-836-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25695333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy