Provider Demographics
NPI:1942574801
Name:17TH STREET PHARMACY & DISCOUNT, INC
Entity Type:Organization
Organization Name:17TH STREET PHARMACY & DISCOUNT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG PHARMACY TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYSI
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ZAYAS-ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-903-6108
Mailing Address - Street 1:1691 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2162
Mailing Address - Country:US
Mailing Address - Phone:786-362-5997
Mailing Address - Fax:786-558-8643
Practice Address - Street 1:1691 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2162
Practice Address - Country:US
Practice Address - Phone:786-362-5997
Practice Address - Fax:786-558-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy