Provider Demographics
NPI:1053687798
Name:G.M.G PHARMACY AND DISCOUNT
Entity type:Organization
Organization Name:G.M.G PHARMACY AND DISCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOIRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-558-8880
Mailing Address - Street 1:2215 W 4TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1419
Mailing Address - Country:US
Mailing Address - Phone:786-558-8880
Mailing Address - Fax:786-558-8838
Practice Address - Street 1:2215 W 4TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1419
Practice Address - Country:US
Practice Address - Phone:786-558-8880
Practice Address - Fax:786-558-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy