Provider Demographics
NPI:1962846287
Name:SAN NICOLAS PHARMACY CORP
Entity Type:Organization
Organization Name:SAN NICOLAS PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-953-7224
Mailing Address - Street 1:2140 W FLAGLER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-5600
Mailing Address - Country:US
Mailing Address - Phone:786-953-7224
Mailing Address - Fax:786-953-7519
Practice Address - Street 1:2140 W FLAGLER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5600
Practice Address - Country:US
Practice Address - Phone:786-953-7224
Practice Address - Fax:786-953-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 26799333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy