Provider Demographics
NPI:1164208609
Name:ST JUDE PHARMACY & DISCOUNT 2 INC
Entity type:Organization
Organization Name:ST JUDE PHARMACY & DISCOUNT 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUREIBYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-953-6339
Mailing Address - Street 1:3474 W 60 ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4409
Mailing Address - Country:US
Mailing Address - Phone:786-953-6339
Mailing Address - Fax:786-953-6313
Practice Address - Street 1:3474 W 60 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4409
Practice Address - Country:US
Practice Address - Phone:786-953-6339
Practice Address - Fax:786-953-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy