Provider Demographics
NPI:1821213133
Name:JERRY PHARMACY AND MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:JERRY PHARMACY AND MEDICAL SUPPLY INC
Other - Org Name:JERRY PHARMACY AND MEDICAL SUPPLY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-225-5007
Mailing Address - Street 1:3855 SW 137TH AVE
Mailing Address - Street 2:13
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 SW 137TH AVE
Practice Address - Street 2:13
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8820
Practice Address - Country:US
Practice Address - Phone:305-225-5007
Practice Address - Fax:305-225-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH225243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1032628OtherOTHER ID NUMBER
1032628OtherOTHER ID NUMBER