1033550777 NPI number — AG BENS DISCOUNT PHARMACY

Table of content: (NPI 1033550777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033550777 NPI number — AG BENS DISCOUNT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AG BENS DISCOUNT PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AG BEN'S DISCOUNT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033550777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10521 SW 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-3747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-553-6355
Provider Business Mailing Address Fax Number:
305-553-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10521 SW 40TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33165-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-553-6355
Provider Business Practice Location Address Fax Number:
305-553-6333
Provider Enumeration Date:
07/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCO
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-553-6355

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH26932 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2141140 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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