Provider Demographics
NPI:1760775415
Name:FIRST PHARMACY CORP
Entity Type:Organization
Organization Name:FIRST PHARMACY CORP
Other - Org Name:FIRST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-681-4090
Mailing Address - Street 1:551 E 49TH ST STE 16
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1911
Mailing Address - Country:US
Mailing Address - Phone:305-681-4090
Mailing Address - Fax:305-681-4050
Practice Address - Street 1:551 E 49TH ST STE 16
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1911
Practice Address - Country:US
Practice Address - Phone:305-681-4090
Practice Address - Fax:305-681-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH282323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142566OtherPK