Provider Demographics
NPI:1124113949
Name:FIS'S CARE PHARMACY,INC.
Entity type:Organization
Organization Name:FIS'S CARE PHARMACY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISANDRO
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-256-1180
Mailing Address - Street 1:15190 SW 136TH ST STE 27
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2618
Mailing Address - Country:US
Mailing Address - Phone:305-256-1180
Mailing Address - Fax:305-256-1189
Practice Address - Street 1:15190 SW 136TH ST STE 27
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2618
Practice Address - Country:US
Practice Address - Phone:305-256-1180
Practice Address - Fax:305-256-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH214643336S0011X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031135901OtherMEDICAID DME
FL031135900Medicaid
FL031135901OtherMEDICAID DME