Provider Demographics
NPI:1386837870
Name:MY PHARMACY CLOSED DOOR PHARMACY
Entity type:Organization
Organization Name:MY PHARMACY CLOSED DOOR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ORIN
Authorized Official - Middle Name:ELBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-238-2474
Mailing Address - Street 1:15043 S DIXIE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7930
Mailing Address - Country:US
Mailing Address - Phone:305-238-2474
Mailing Address - Fax:305-252-4196
Practice Address - Street 1:15043 S DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7930
Practice Address - Country:US
Practice Address - Phone:305-238-2474
Practice Address - Fax:305-252-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH19817332B00000X, 332BP3500X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy