Provider Demographics
NPI:1881972479
Name:MY FAMILY PHARMACY & DISCOUNT
Entity type:Organization
Organization Name:MY FAMILY PHARMACY & DISCOUNT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-200-5973
Mailing Address - Street 1:8410 W FLAGLER ST
Mailing Address - Street 2:SUITE 105-B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-200-5973
Mailing Address - Fax:305-603-8534
Practice Address - Street 1:8410 W FLAGLER ST STE 105B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2041
Practice Address - Country:US
Practice Address - Phone:305-200-5973
Practice Address - Fax:305-603-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH255913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131740OtherPK
FL004318700Medicaid
FL004318700Medicaid