1932421294 NPI number — SOUTH MIAMI PHARMACY II LLC

Table of content: (NPI 1932421294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932421294 NPI number — SOUTH MIAMI PHARMACY II LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH MIAMI PHARMACY II LLC
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:
SMP PHARMACY SOLUTIONS #2
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:
1932421294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 NW 26TH ST STE 102
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:
33122-1414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-740-9744
Provider Business Mailing Address Fax Number:
866-301-1364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 NW 26TH ST STE 102
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:
33122-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-740-9744
Provider Business Practice Location Address Fax Number:
866-301-1364
Provider Enumeration Date:
02/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
QUALITY AND PROJECT MANAGER
Authorized Official Telephone Number:
305-740-9720

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH24479 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4685 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHNR000653 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: FL1902 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054.018826 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: A9-0001623 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCN.0002784 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 22-45095 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: OSP.0006337 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 114173 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 64001666A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NRX0000656 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NRP1929 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 47705MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PMP-1420 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 003161200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2124289 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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