Provider Demographics
NPI:1134211444
Name:HUMANITARY PHARMACY INC
Entity type:Organization
Organization Name:HUMANITARY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:LICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-263-6773
Mailing Address - Street 1:4152 SW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4414
Mailing Address - Country:US
Mailing Address - Phone:305-263-6773
Mailing Address - Fax:305-263-6774
Practice Address - Street 1:4152 SW 74TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4414
Practice Address - Country:US
Practice Address - Phone:305-263-6773
Practice Address - Fax:305-263-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH200343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006914OtherOTHER ID NUMBER
5229850001Medicare NSC