Provider Demographics
NPI:1932421294
Name:SOUTH MIAMI PHARMACY II LLC
Entity Type:Organization
Organization Name:SOUTH MIAMI PHARMACY II LLC
Other - Org Name:SMP PHARMACY SOLUTIONS #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QUALITY AND PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-740-9720
Mailing Address - Street 1:7500 NW 26TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1414
Mailing Address - Country:US
Mailing Address - Phone:305-740-9744
Mailing Address - Fax:866-301-1364
Practice Address - Street 1:7500 NW 26TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1414
Practice Address - Country:US
Practice Address - Phone:305-740-9744
Practice Address - Fax:866-301-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH244793336C0003X
IA46853336C0003X
GAPHNR0006533336C0003X
KYFL19023336C0003X
IL054.0188263336C0003X
DEA9-00016233336C0003X
CTPCN.00027843336C0003X
KS22-450953336C0003X
COOSP.00063373336C0003X
AL1141733336C0003X
IN64001666A3336C0003X
DCNRX00006563336C0003X
CANRP19293336C0003X
ID47705MS3336C0003X
HIPMP-14203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003161200Medicaid
2124289OtherPK