Provider Demographics
NPI:1306978036
Name:REDONDO PHARMACY
Entity type:Organization
Organization Name:REDONDO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-625-0225
Mailing Address - Street 1:19533 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4709
Mailing Address - Country:US
Mailing Address - Phone:305-625-0225
Mailing Address - Fax:305-625-0253
Practice Address - Street 1:19533 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-4709
Practice Address - Country:US
Practice Address - Phone:305-625-0225
Practice Address - Fax:305-625-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5519190001332B00000X
FLPH6665333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5519190001Medicare ID - Type Unspecified