Organization
PROMINENT MEDICAL INC
Active
Other names
PROMINENT MEDICAL INC.
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND HARRIS PHARM D (OWNER)
(786) 573-1712
Entity
Organization
Contact information
Practice address
17452 SW 104TH AVE, MIAMI, FL 33157-4200
(786) 573-1712
(305) 969-3115
Mailing address
17452 SW 104TH AVE, MIAMI, FL 33157-4200
(786) 573-1712
(305) 969-3115
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5702774
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/21/2010
Last updated
11/23/2010
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