Organization
EL SHADAI PHCY DISCOUNT
Active
Organization
EL SHADAI PHCY DISCOUNT
Active
Other names
EL SHADAI MED EQUIP INC
Organization subpart
No
Provider details
NPI number
Authorized official
ALCIVIADES CISNEROS (OWNER)
(786) 344-0505
Entity
Organization
Contact information
Practice address
7911 NW 72ND AVE, STE 118B, MEDLEY, FL 33166-2227
(305) 863-3361
(305) 863-3550
Mailing address
7911 NW 72ND AVE, STE 118B, MEDLEY, FL 33166-2227
(305) 863-3361
(305) 863-3550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22032
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1019707
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/14/2006
Last updated
01/14/2010
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