Provider Demographics
NPI:1790216950
Name:BAPTIST PHARMACY DISCOUNT INC
Entity Type:Organization
Organization Name:BAPTIST PHARMACY DISCOUNT INC
Other - Org Name:BAPTIST PHARMACY DISCOUNT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLO GINIEBRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-212-1315
Mailing Address - Street 1:7305 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6704
Mailing Address - Country:US
Mailing Address - Phone:786-212-1315
Mailing Address - Fax:786-391-4059
Practice Address - Street 1:7305 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6704
Practice Address - Country:US
Practice Address - Phone:786-212-1315
Practice Address - Fax:786-212-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH307903336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10077600Medicaid