Provider Demographics
NPI:1912093691
Name:CAMILLUS PHARMACY
Entity Type:Organization
Organization Name:CAMILLUS PHARMACY
Other - Org Name:CAMILLUS PHARMACY & DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATHERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-221-3441
Mailing Address - Street 1:10780 W FLAGLER ST STE 15
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4403
Mailing Address - Country:US
Mailing Address - Phone:305-221-3441
Mailing Address - Fax:305-221-3466
Practice Address - Street 1:10780 W FLAGLER ST STE 15
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4403
Practice Address - Country:US
Practice Address - Phone:305-221-3441
Practice Address - Fax:305-221-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH184443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25464900Medicaid
FL25464901Medicaid
FL25464900Medicaid