Provider Demographics
NPI:1386939072
Name:YOUTH PHARMACY INC
Entity type:Organization
Organization Name:YOUTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUILLEN
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:2011-06-10
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH254803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25480OtherFLA