Provider Demographics
NPI:1790236339
Name:SPRING DRUG STORE, INC
Entity Type:Organization
Organization Name:SPRING DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SADIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASULTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-7333
Mailing Address - Street 1:450 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4754
Mailing Address - Country:US
Mailing Address - Phone:305-863-7333
Mailing Address - Fax:305-863-7399
Practice Address - Street 1:450 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4754
Practice Address - Country:US
Practice Address - Phone:305-863-7333
Practice Address - Fax:305-863-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty