Provider Demographics
NPI:1912068024
Name:CORAL WAY PHARMACY
Entity type:Organization
Organization Name:CORAL WAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-VP-TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-5177
Mailing Address - Street 1:6965 SW 24 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1705
Mailing Address - Country:US
Mailing Address - Phone:305-266-5177
Mailing Address - Fax:305-267-2524
Practice Address - Street 1:6965 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1705
Practice Address - Country:US
Practice Address - Phone:305-266-5177
Practice Address - Fax:305-267-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1159800001Medicare ID - Type Unspecified