Provider Demographics
NPI:1881010486
Name:NEW PHARMACY AND STORE CORP
Entity Type:Organization
Organization Name:NEW PHARMACY AND STORE CORP
Other - Org Name:NEW PHARMACY AND STORE CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-703-6580
Mailing Address - Street 1:1204 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3502
Mailing Address - Country:US
Mailing Address - Phone:786-703-6580
Mailing Address - Fax:786-703-6581
Practice Address - Street 1:1204 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3502
Practice Address - Country:US
Practice Address - Phone:786-703-6580
Practice Address - Fax:786-703-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH275663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144464OtherPK