Provider Demographics
NPI:1285995696
Name:YOUTH PHARMACY INC
Entity type:Organization
Organization Name:YOUTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SARABIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-2848
Mailing Address - Street 1:10788 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2499
Mailing Address - Country:US
Mailing Address - Phone:305-220-2848
Mailing Address - Fax:305-220-2849
Practice Address - Street 1:10788 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2499
Practice Address - Country:US
Practice Address - Phone:305-220-2848
Practice Address - Fax:305-220-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25479333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH25479OtherSPECIAL CLOSED