Provider Demographics
NPI:1255525341
Name:LAS VILLAS PHARMACY DISCOUNT AND MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:LAS VILLAS PHARMACY DISCOUNT AND MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-883-7476
Mailing Address - Street 1:716 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5606
Mailing Address - Country:US
Mailing Address - Phone:305-883-7476
Mailing Address - Fax:305-883-7479
Practice Address - Street 1:716 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5606
Practice Address - Country:US
Practice Address - Phone:305-883-7476
Practice Address - Fax:305-883-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 228923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN
FL=========OtherEIN