Provider Demographics
NPI:1790055382
Name:PALM AVE PHARMACY DISCOUNT CORPORATION
Entity Type:Organization
Organization Name:PALM AVE PHARMACY DISCOUNT CORPORATION
Other - Org Name:PALM AVE PHARMACY DISCOUNT CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-287-7374
Mailing Address - Street 1:1301 PALM AVE
Mailing Address - Street 2:STE #105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3463
Mailing Address - Country:US
Mailing Address - Phone:305-887-7979
Mailing Address - Fax:305-887-7909
Practice Address - Street 1:1301 PALM AVE UNIT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3461
Practice Address - Country:US
Practice Address - Phone:305-887-7979
Practice Address - Fax:305-887-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH258823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708726OtherNCPDP PROVIDER IDENTIFICATION NUMBER