Healthcare Provider Details

I. General information

NPI: 1760854756
Provider Name (Legal Business Name): SANTOS FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13780 SW 26TH ST SUITE 108
MIAMI FL
33175-6302
US

IV. Provider business mailing address

13780 SW 26TH ST SUITE 108
MIAMI FL
33175-6302
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-4595
  • Fax: 305-553-4596
Mailing address:
  • Phone: 305-553-4595
  • Fax: 305-553-4596

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: ORQUIDEA SANTOS
Title or Position: PRESIDENT
Credential:
Phone: 305-553-4595