Provider Demographics
NPI:1215454061
Name:RED ALAMO CORP
Entity type:Organization
Organization Name:RED ALAMO CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAIRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARECHAVALETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-391-0408
Mailing Address - Street 1:2140 W FLAGLER ST
Mailing Address - Street 2:SUITE # 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-5600
Mailing Address - Country:US
Mailing Address - Phone:786-391-0408
Mailing Address - Fax:305-456-7756
Practice Address - Street 1:2140 W FLAGLER ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1662
Practice Address - Country:US
Practice Address - Phone:786-391-0408
Practice Address - Fax:305-456-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH309243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172224OtherPK
FL023280400Medicaid