Provider Demographics
NPI:1811045180
Name:PROPHARMACY & DISCOUNT
Entity Type:Organization
Organization Name:PROPHARMACY & DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-244-9433
Mailing Address - Street 1:11478 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6575
Mailing Address - Country:US
Mailing Address - Phone:305-971-3388
Mailing Address - Fax:305-971-3306
Practice Address - Street 1:11478 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6575
Practice Address - Country:US
Practice Address - Phone:305-971-3388
Practice Address - Fax:305-971-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 21025333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026966200Medicaid
FL1082584OtherNABP
FL1082584OtherNABP