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Organization

MAR-LAC PHARMACY DISCOUNT & SUPPLY CORP

Active
Other names
Mar-Lac Pharmacy Discount & Supply
Organization subpart
No

Provider details

NPI number
Authorized official
ERNESTO DIAZ (PRESIDENT)
(305) 631-6602
Entity
Organization

Contact information

Practice address
1109 NW 22ND AVE, MIAMI, FL 33125-2738
(305) 631-6602
(305) 631-6603
Mailing address
1109 NW 22ND AVE, MIAMI, FL 33125-2738
(305) 631-6602
(305) 631-6603

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
PH23601
FL
3336L0003X
Long Term Care Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2126986
PK
Enumeration date
09/30/2008
Last updated
08/15/2017
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