Healthcare Provider Details

I. General information

NPI: 1639253685
Provider Name (Legal Business Name): SOUTH MIAMI PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 SW 72ND ST
SOUTH MIAMI FL
33143-4804
US

IV. Provider business mailing address

6050 S DIXIE HWY
SOUTH MIAMI FL
33143-5042
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-6150
  • Fax: 305-668-6137
Mailing address:
  • Phone: 305-740-9696
  • Fax: 305-740-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19287
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARMANDO BARDISA
Title or Position: PHARMACIST OWNER
Credential: PHARM D
Phone: 305-668-6150