Healthcare Provider Details

I. General information

NPI: 1821189192
Provider Name (Legal Business Name): CABANA PHARMACY , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NW 29TH ST
MIAMI FL
33127-3951
US

IV. Provider business mailing address

5201 PINE TREE DR
MIAMI BEACH FL
33140-2109
US

V. Phone/Fax

Practice location:
  • Phone: 305-573-8172
  • Fax: 305-573-9575
Mailing address:
  • Phone: 305-229-9685
  • Fax: 305-573-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOLORES C MARTINEZ
Title or Position: OWNER
Credential:
Phone: 305-573-8172