Organization
GREY DOG IV, INC
Active
Other names
Ethos Wellness Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL PARRA RPT, CPHT (TREASURER)
(305) 781-7768
Entity
Organization
Contact information
Practice address
260 CRANDON BLVD STE 33, KEY BISCAYNE, FL 33149-1538
(305) 982-8727
Mailing address
260 CRANDON BLVD STE 33, KEY BISCAYNE, FL 33149-1538
(305) 982-8727
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH31442
FL
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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