Organization
COUNTRY CLUB PHARMACY & 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
3336L0003X
Long Term Care Pharmacy
Primary
PH26903
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3719
NUMB
FL
Enumeration date
07/17/2013
Last updated
07/17/2013
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