Provider Demographics
NPI:1801219787
Name:BI COUNTY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:BI COUNTY MEDICAL SUPPLY INC
Other - Org Name:LA COLONIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-BATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-637-0666
Mailing Address - Street 1:1662 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5572
Mailing Address - Country:US
Mailing Address - Phone:305-637-0666
Mailing Address - Fax:305-637-0740
Practice Address - Street 1:8377 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6607
Practice Address - Country:US
Practice Address - Phone:954-438-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH273833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144103OtherPK