Healthcare Provider Details

I. General information

NPI: 1619219565
Provider Name (Legal Business Name): PHARMCO 780 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 FISHERMAN ST # 103
OPA LOCKA FL
33054-3806
US

IV. Provider business mailing address

1111 PARK CENTRE BLVD #207
MIAMI GARDENS FL
33169-5365
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-2060
  • Fax: 786-955-6619
Mailing address:
  • Phone: 786-657-2060
  • Fax: 786-955-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26739
License Number StateFL

VIII. Authorized Official

Name: RODRIGO LINDER
Title or Position: MANAGER
Credential:
Phone: 305-919-7399