Provider Demographics
NPI:1053619478
Name:ANGELIZ PHARMACY DISCOUNT INC
Entity type:Organization
Organization Name:ANGELIZ PHARMACY DISCOUNT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ DE LLADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-327-7280
Mailing Address - Street 1:5496 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2105
Mailing Address - Country:US
Mailing Address - Phone:305-819-3660
Mailing Address - Fax:305-819-3661
Practice Address - Street 1:5496 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2105
Practice Address - Country:US
Practice Address - Phone:305-819-3660
Practice Address - Fax:305-819-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5428OtherDOC NUMBER