Provider Demographics
NPI:1700991825
Name:NAVARRO DISCOUNT PHARMACIES NO.12
Entity Type:Organization
Organization Name:NAVARRO DISCOUNT PHARMACIES NO.12
Other - Org Name:NAVARRO DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-636-7779
Mailing Address - Street 1:9400 NW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1333
Mailing Address - Country:US
Mailing Address - Phone:305-636-7779
Mailing Address - Fax:305-636-6236
Practice Address - Street 1:10141 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3978
Practice Address - Country:US
Practice Address - Phone:305-636-7779
Practice Address - Fax:954-442-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL031866301332B00000X
FLPH0017341333600000X
FL4541650001333600000X
FL031866300333600000X
FL1090187333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031866301Medicaid
FL031866300Medicaid
FL1090187OtherNCPDP
FL4541650001Medicare NSC