Provider Demographics
NPI:1851330831
Name:INTERAMERICAN SERVICES CORPORATION
Entity Type:Organization
Organization Name:INTERAMERICAN SERVICES CORPORATION
Other - Org Name:MY PHARMACY DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-805-9671
Mailing Address - Street 1:3835 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2703
Mailing Address - Country:US
Mailing Address - Phone:305-805-9671
Mailing Address - Fax:305-805-2043
Practice Address - Street 1:3835 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2703
Practice Address - Country:US
Practice Address - Phone:305-805-9671
Practice Address - Fax:305-805-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3201071332BP3500X
FLPH273243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0996750001Medicare NSC