Healthcare Provider Details

I. General information

NPI: 1548572092
Provider Name (Legal Business Name): NMB GENERICS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 N MIAMI AVE
MIAMI FL
33169-6026
US

IV. Provider business mailing address

16600 N MIAMI AVE
MIAMI FL
33169-6026
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-4510
  • Fax: 305-454-9748
Mailing address:
  • Phone: 305-974-4510
  • Fax: 305-454-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH24730
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH24730
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24730
License Number StateFL

VIII. Authorized Official

Name: LORIE GRESS
Title or Position: OWNER
Credential:
Phone: 305-974-4510