Provider Demographics
NPI:1982918512
Name:KIARA DISCOUNT PHARMACY COR
Entity Type:Organization
Organization Name:KIARA DISCOUNT PHARMACY COR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-201-4666
Mailing Address - Street 1:9620 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3250
Mailing Address - Country:US
Mailing Address - Phone:786-201-4666
Mailing Address - Fax:305-477-6518
Practice Address - Street 1:9620 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3250
Practice Address - Country:US
Practice Address - Phone:786-201-4666
Practice Address - Fax:305-477-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy