Provider Demographics
NPI:1285079400
Name:SIXTYSEVEN PHARMACY DISCOUNT INC
Entity type:Organization
Organization Name:SIXTYSEVEN PHARMACY DISCOUNT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-2313
Mailing Address - Street 1:2205 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1839
Mailing Address - Country:US
Mailing Address - Phone:305-261-2313
Mailing Address - Fax:
Practice Address - Street 1:2205 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1839
Practice Address - Country:US
Practice Address - Phone:305-261-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH26470333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy