Healthcare Provider Details

I. General information

NPI: 1104281609
Provider Name (Legal Business Name): CORAL PHARMACY MIAMI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 SW 8TH ST
CORAL GABLES FL
33134-2269
US

IV. Provider business mailing address

5309 SW 8TH ST
CORAL GABLES FL
33134-2269
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-8488
  • Fax: 786-542-8488
Mailing address:
  • Phone: 305-510-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OSCLEIDY RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 305-510-9634