Provider Demographics
NPI:1891003364
Name:COSTASUR PHARMACY, INC.
Entity Type:Organization
Organization Name:COSTASUR PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMANY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMBAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-712-9463
Mailing Address - Street 1:3421 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4107
Mailing Address - Country:US
Mailing Address - Phone:786-712-9463
Mailing Address - Fax:
Practice Address - Street 1:3421 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4107
Practice Address - Country:US
Practice Address - Phone:786-712-9463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy