Organization
COUNTRY CLUB PHARMACY AND DISCOUNT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAISY MARTINEZ (PRESIDENT)
(305) 828-8600
Entity
Organization
Contact information
Practice address
5911 NW 173RD DR, # 6, HIALEAH, FL 33015-5121
(305) 828-8600
(305) 828-8630
Mailing address
5911 NW 173RD DR, # 6, HIALEAH, FL 33015-5121
(305) 828-8600
(305) 828-8630
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37199
DOCUMENT NUMBER
FL
Enumeration date
10/22/2010
Last updated
10/22/2010
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