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General NPI Number Information
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NPI Number | 1063714111
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Entity Type | Organization
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Legal Business Name | CORAL GABLES PHARMACY AND MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 3160 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33134-6826
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Country | US
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Telephone | 305-444-5115
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Fax | 305-444-5119
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Provider Business Mailing Address
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Address Line | 3160 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33134-6826
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Country | US
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Telephone | 305-444-5115
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Fax | 305-444-5119
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | RICARDO PAEZ
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Credential |
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Telephone | 305-444-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25066
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License Number State | FL
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