Provider Demographics
NPI:1740426758
Name:CHARLIE RX INC
Entity Type:Organization
Organization Name:CHARLIE RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-688-3891
Mailing Address - Street 1:551 E 49TH ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1904
Mailing Address - Country:US
Mailing Address - Phone:305-681-8389
Mailing Address - Fax:305-681-8398
Practice Address - Street 1:551 E 49TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1904
Practice Address - Country:US
Practice Address - Phone:305-681-8389
Practice Address - Fax:305-681-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6218530001Medicare NSC