Provider Demographics
NPI:1386741643
Name:PHARMACOS SERVICES INC
Entity type:Organization
Organization Name:PHARMACOS SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIETA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-637-8444
Mailing Address - Street 1:2341 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7231
Mailing Address - Country:US
Mailing Address - Phone:305-637-8444
Mailing Address - Fax:305-637-8364
Practice Address - Street 1:2341 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7231
Practice Address - Country:US
Practice Address - Phone:305-637-8444
Practice Address - Fax:305-637-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL025625101332B00000X
FLPH18713332B00000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1096418OtherNABP
FL025625100Medicaid
FL025625101Medicaid
FL1096418OtherNABP