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General NPI Number Information
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NPI Number | 1952619033
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Entity Type | Organization
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Legal Business Name | BLACK & WHITE PHARMACY CORP
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 8381 BIRD RD
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City | MIAMI
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State | FL
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Zip | 33155-3353
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Country | US
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Telephone | 305-545-2108
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Fax | 305-545-2156
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Provider Business Mailing Address
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Address Line | 8381 BIRD RD
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City | MIAMI
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State | FL
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Zip | 33155-3353
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Country | US
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Telephone | 305-545-2108
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Fax | 305-545-2156
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRMAYUN HIDALGO HERNANDEZ
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Credential |
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Telephone | 305-545-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | PH25045
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25045
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License Number State | FL
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