1396188769 NPI number — ANDYS PHARMACY AND DISCOUNT

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 1396188769 NPI number — ANDYS PHARMACY AND DISCOUNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDYS PHARMACY AND DISCOUNT
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:
ANDY'S PHARMACY AND DISCOUNT INC
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:
1396188769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4315 NW 7TH ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-3587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-443-3507
Provider Business Mailing Address Fax Number:
305-443-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 NW 7TH ST STE 15
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:
33126-3560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-443-3507
Provider Business Practice Location Address Fax Number:
305-443-3510
Provider Enumeration Date:
04/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ERICE
Authorized Official First Name:
RAISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-443-3507

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH29946 , 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: 2141025 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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