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General NPI Number Information
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NPI Number | 1275019705
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Entity Type | Organization
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Legal Business Name | GREY DOG IV, INC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 260 CRANDON BLVD STE 33
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City | KEY BISCAYNE
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State | FL
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Zip | 33149-1538
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Country | US
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Telephone | 305-982-8727
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Fax |
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Provider Business Mailing Address
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Address Line | 260 CRANDON BLVD STE 33
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City | KEY BISCAYNE
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State | FL
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Zip | 33149-1538
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Country | US
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Telephone | 305-982-8727
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | RAFAEL PARRA
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Credential | RPT, CPHT
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Telephone | 305-781-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH31442
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License Number State | FL
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