Provider Demographics
NPI:1932490695
Name:PET MEDS AND BEYOND
Entity Type:Organization
Organization Name:PET MEDS AND BEYOND
Other - Org Name:PET MEDS AND BEYOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DISLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-228-8537
Mailing Address - Street 1:2501 W 80TH ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2719
Mailing Address - Country:US
Mailing Address - Phone:786-228-8537
Mailing Address - Fax:866-287-8403
Practice Address - Street 1:2501 W 80TH ST UNIT 7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2719
Practice Address - Country:US
Practice Address - Phone:786-228-8537
Practice Address - Fax:866-287-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH253123336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5705415OtherNCPDP PROVIDER IDENTIFICATION NUMBER