Provider Demographics
NPI:1902987365
Name:UNIVERSAL PHARMACY & DISCOUNT
Entity Type:Organization
Organization Name:UNIVERSAL PHARMACY & DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-5449
Mailing Address - Street 1:13427 SW 56 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175
Mailing Address - Country:US
Mailing Address - Phone:305-221-7921
Mailing Address - Fax:305-223-4729
Practice Address - Street 1:13427 SW 56 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-221-7921
Practice Address - Fax:305-223-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0012357333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102360800Medicaid
FL1070109OtherNAPB
FL=========OtherFL LICENSE TAXPAYER
FL1220010001Medicare NSC
FL102360800Medicaid