Healthcare Provider Details

I. General information

NPI: 1407255672
Provider Name (Legal Business Name): GOLD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 E 10TH ST
HIALEAH FL
33010-3636
US

IV. Provider business mailing address

758 E 10TH ST
HIALEAH FL
33010-3636
US

V. Phone/Fax

Practice location:
  • Phone: 786-391-3907
  • Fax: 786-391-3915
Mailing address:
  • Phone: 786-391-3907
  • Fax: 786-391-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateFL

VIII. Authorized Official

Name: CARLOS CAMACHO
Title or Position: PRESIDENT
Credential:
Phone: 786-391-3907