Healthcare Provider Details

I. General information

NPI: 1982918512
Provider Name (Legal Business Name): KIARA DISCOUNT PHARMACY COR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 SW 72ND ST
MIAMI FL
33173-3250
US

IV. Provider business mailing address

9620 SW 72ND ST
MIAMI FL
33173-3250
US

V. Phone/Fax

Practice location:
  • Phone: 786-201-4666
  • Fax: 305-477-6518
Mailing address:
  • Phone: 786-201-4666
  • Fax: 305-477-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JESUS FUNDORA
Title or Position: PRESIDENT
Credential:
Phone: 786-201-4666