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General NPI Number Information
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NPI Number | 1629333646
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Entity Type | Organization
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Legal Business Name | DELTA DRUG DISCOUNT CORP
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 3240 NW 72ND AVE
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City | MIAMI
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State | FL
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Zip | 33122-1318
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Country | US
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Telephone | 305-593-6230
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Fax | 305-593-6229
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Provider Business Mailing Address
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Address Line | 3240 NW 72ND AVE
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City | MIAMI
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State | FL
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Zip | 33122-1318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GLADYS HERNANDEZ
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Credential |
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Telephone | 305-593-6230
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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 | PH26228
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License Number State | FL
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