Provider Demographics
NPI:1235319211
Name:NAVARRO DISCOUNT PHARMACIES NO. 24 LLC
Entity type:Organization
Organization Name:NAVARRO DISCOUNT PHARMACIES NO. 24 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RX MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUREA MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-636-7779
Mailing Address - Street 1:9400 NW 104TH STREET
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1333
Mailing Address - Country:US
Mailing Address - Phone:305-636-7779
Mailing Address - Fax:
Practice Address - Street 1:2323 N 60TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3203
Practice Address - Country:US
Practice Address - Phone:305-636-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL032305501332B00000X
FL032305500332B00000X
FL1030268333600000X
FLPH0023055333600000X
FL6099000001333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032305500Medicaid
FL032305501Medicaid
FL1030268OtherNCPDP
FL6099000001Medicare NSC