Provider Demographics
NPI:1811179021
Name:GREY DOG II INC
Entity type:Organization
Organization Name:GREY DOG II INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-666-1648
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:STE 102
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-666-1605
Mailing Address - Fax:305-666-1688
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:STE 102
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-666-1605
Practice Address - Fax:305-666-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH230913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010260OtherPK
FL001218200Medicaid
FL001218200Medicaid