Provider Demographics
NPI:1962594515
Name:ROSY'S PHARMACY
Entity type:Organization
Organization Name:ROSY'S PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:305-362-1515
Mailing Address - Street 1:2050 W 56TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2683
Mailing Address - Country:US
Mailing Address - Phone:305-362-1515
Mailing Address - Fax:305-362-0797
Practice Address - Street 1:2050 W 56TH ST STE 8
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2683
Practice Address - Country:US
Practice Address - Phone:305-362-1515
Practice Address - Fax:305-362-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025529700Medicaid