Provider Demographics
NPI:1972875623
Name:PRICE CHOICE PHARMACY 3
Entity Type:Organization
Organization Name:PRICE CHOICE PHARMACY 3
Other - Org Name:PRICECHOICE PHARMACY 3 , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-685-3100
Mailing Address - Street 1:13931 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3652
Mailing Address - Country:US
Mailing Address - Phone:305-685-3110
Mailing Address - Fax:305-685-3111
Practice Address - Street 1:13931 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3652
Practice Address - Country:US
Practice Address - Phone:305-685-3110
Practice Address - Fax:305-685-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25903333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137289OtherPK