=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639317779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTOS SUAREZ PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2009
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11300 NW 87TH CT 149
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-4586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-2904
-----------------------------------------------------
Fax | 305-821-2905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11300 NW 87TH CT 149
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-4586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-2904
-----------------------------------------------------
Fax | 305-821-2905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TANIA ALVAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-821-2904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH23951
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------