Provider Demographics
NPI:1285872937
Name:PHARMLAND
Entity type:Organization
Organization Name:PHARMLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MAZARIEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:727-209-1282
Mailing Address - Street 1:3426 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5424
Mailing Address - Country:US
Mailing Address - Phone:727-209-1282
Mailing Address - Fax:
Practice Address - Street 1:3426 13TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5424
Practice Address - Country:US
Practice Address - Phone:727-209-1282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH238753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000609300Medicaid
FL6245520002Medicare NSC