Provider Demographics
NPI:1770856783
Name:GOLDEN PALM PHARMACY CORP
Entity Type:Organization
Organization Name:GOLDEN PALM PHARMACY CORP
Other - Org Name:GOLDEN PALM PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-2230
Mailing Address - Street 1:6900 W 32ND AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5227
Mailing Address - Country:US
Mailing Address - Phone:305-827-2230
Mailing Address - Fax:305-827-2238
Practice Address - Street 1:6900 W 32ND AVE
Practice Address - Street 2:STE 16
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5227
Practice Address - Country:US
Practice Address - Phone:305-827-2230
Practice Address - Fax:305-827-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5709312OtherNCPDP PROVIDER IDENTIFICATION NUMBER