1528468956 NPI number — CENTRO MEDICO FAMILIAR BUEN PASTOR PHARMACY

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 1528468956 NPI number — CENTRO MEDICO FAMILIAR BUEN PASTOR PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO FAMILIAR BUEN PASTOR 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:
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:
1528468956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4440 SHERIDAN ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-882-0191
Provider Business Mailing Address Fax Number:
754-210-3962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 SHERIDAN ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-882-0191
Provider Business Practice Location Address Fax Number:
754-210-3962
Provider Enumeration Date:
09/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FLOREZ
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
786-218-1160

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  ACN 285 , 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)





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