Healthcare Provider Details

I. General information

NPI: 1336246172
Provider Name (Legal Business Name): ORLY PHARMACY 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NW 23RD AVE
MIAMI FL
33125-3298
US

IV. Provider business mailing address

711 NW 23RD AVE
MIAMI FL
33125-3298
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-4641
  • Fax: 305-642-7701
Mailing address:
  • Phone: 305-642-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH12537
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEIDET FERNANDEZ
Title or Position: VP
Credential:
Phone: 305-642-4641