Provider Demographics
NPI:1952408163
Name:HIALEAH MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:HIALEAH MEDICAL SUPPLIES CORP
Other - Org Name:HIALEAH MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-362-4118
Mailing Address - Street 1:8325 W 24TH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8325 W 24TH AVE STE 7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1880
Practice Address - Country:US
Practice Address - Phone:305-362-4118
Practice Address - Fax:305-362-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH228413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033555OtherOTHER ID NUMBER