=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972975829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAND PHARMACY - DISCOUNT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2015
-----------------------------------------------------
Last Update Date | 10/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12486 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-615-3586
-----------------------------------------------------
Fax | 786-615-3679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12486 SW 8 ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-615-3586
-----------------------------------------------------
Fax | 786-615-3679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. TERESA TORRES
-----------------------------------------------------
Credential | RPT
-----------------------------------------------------
Telephone | 786-615-3586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH29308
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------