Provider Demographics
NPI:1336246172
Name:ORLY PHARMACY 2 INC
Entity type:Organization
Organization Name:ORLY PHARMACY 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LEIDET
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-4641
Mailing Address - Street 1:711 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3298
Mailing Address - Country:US
Mailing Address - Phone:305-642-4641
Mailing Address - Fax:
Practice Address - Street 1:711 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3298
Practice Address - Country:US
Practice Address - Phone:305-642-4641
Practice Address - Fax:305-642-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH12537333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083271OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1083271OtherOTHER ID NUMBER-COMMERCIAL NUMBER