Provider Demographics
NPI:1861470999
Name:PALM AVENUE PHAR,MACY, INC.
Entity Type:Organization
Organization Name:PALM AVENUE PHAR,MACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-9060
Mailing Address - Street 1:400 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4718
Mailing Address - Country:US
Mailing Address - Phone:305-863-9060
Mailing Address - Fax:305-863-4142
Practice Address - Street 1:400 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4718
Practice Address - Country:US
Practice Address - Phone:305-863-9060
Practice Address - Fax:305-863-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15576332B00000X
FLPH 155763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH15576OtherBOARD OF PHARMACY PERMIT
FLPH15576OtherBOARD OF PHARMACY PERMIT