Provider Demographics
NPI:1669538930
Name:DRUG CENTER INC
Entity type:Organization
Organization Name:DRUG CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEUEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-887-7900
Mailing Address - Street 1:1625 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3000
Mailing Address - Country:US
Mailing Address - Phone:305-887-7900
Mailing Address - Fax:305-887-4820
Practice Address - Street 1:1625 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3000
Practice Address - Country:US
Practice Address - Phone:305-887-7900
Practice Address - Fax:305-887-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH64193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027514OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL103599101Medicaid
FL103599100Medicaid
1027514OtherNCPDP PROVIDER IDENTIFICATION NUMBER