1578877023 NPI number — FIRST CHOICE PHARMACY DISCOUNT CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578877023 NPI number — FIRST CHOICE PHARMACY DISCOUNT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE PHARMACY DISCOUNT CORP
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:
Provider Other Organization Name Type Code:
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:
1578877023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 WEST 12 AVE
Provider Second Line Business Mailing Address:
UNIT 4
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-888-2000
Provider Business Mailing Address Fax Number:
305-888-2070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 WEST 12 AVE
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-888-2000
Provider Business Practice Location Address Fax Number:
305-888-2070
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LUIS
Authorized Official First Name:
MERCEDES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-888-2000

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , 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: 2962 . This is a "DOC NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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