Healthcare Provider Details

I. General information

NPI: 1376957811
Provider Name (Legal Business Name): EXPRESS RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 SW 72 ST SUITE 101
MIAMI FL
33173-4107
US

IV. Provider business mailing address

9999 SW 72 ST SUITE 101
MIAMI FL
33173-4107
US

V. Phone/Fax

Practice location:
  • Phone: 786-420-5601
  • Fax: 786-420-5597
Mailing address:
  • Phone: 786-420-5601
  • Fax: 786-420-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26411
License Number StateFL

VIII. Authorized Official

Name: ORELVYS DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 786-420-5601