Organization
GAVIOTA PHARMACY DISCOUNT CORP
Active
Other names
Gaviota Pharmacy Discount Corp
Organization subpart
No
Provider details
NPI number
Authorized official
ODALYS SANTANA (OWNER)
(305) 223-6469
Entity
Organization
Contact information
Practice address
10521 SW 40TTH STREET, MIAMI, FL 33165-3747
(305) 223-6469
(305) 223-6479
Mailing address
10521 SW 40TTH STREET, MIAMI, FL 33165-3747
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23661
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041475
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/29/2008
Last updated
03/16/2009
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