Provider Demographics
NPI:1023408267
Name:DIAMOND PHARMACY CORP
Entity type:Organization
Organization Name:DIAMOND PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ORIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL REAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-439-9796
Mailing Address - Street 1:13911 SW 42ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6407
Mailing Address - Country:US
Mailing Address - Phone:305-960-7104
Mailing Address - Fax:
Practice Address - Street 1:13911 SW 42ND ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6407
Practice Address - Country:US
Practice Address - Phone:305-960-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28836261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service