Organization
1492 PHARMA GROUP CORP
Active
Other names
MARCO DRUGS AND COMPOUNDING
Organization subpart
No
Provider details
NPI number
Authorized official
SONIA ELENA MARTINEZ BSPHARM (PRESIDENT)
(305) 665-4411
Entity
Organization
Contact information
Practice address
6420 SW 62ND AVE, SOUTH MIAMI, FL 33143-3302
(305) 665-4411
(305) 663-3258
Mailing address
6420 SW 62ND AVE, SOUTH MIAMI, FL 33143-3302
(305) 665-4411
(305) 663-3258
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
PH22048
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007260700
—
FL
05
—
019180600
—
FL
Enumeration date
08/10/2006
Last updated
12/12/2022
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