Provider Demographics
NPI:1255377735
Name:AZALIA'S PHARMACY & DISCOUNT INC.
Entity type:Organization
Organization Name:AZALIA'S PHARMACY & DISCOUNT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACY TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:AZALIA
Authorized Official - Middle Name:DE LA CARIDAD
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-685-9556
Mailing Address - Street 1:428 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1868
Mailing Address - Country:US
Mailing Address - Phone:305-685-9556
Mailing Address - Fax:305-688-0727
Practice Address - Street 1:428 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1868
Practice Address - Country:US
Practice Address - Phone:305-685-9556
Practice Address - Fax:305-688-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH9014332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101557500Medicaid
FL101557501Medicaid
FL6930297100Medicaid
FL101557500Medicaid