Organization
BONANZA STATE PHARMACY AND DISCOUNT CORP
Active
Organization
BONANZA STATE PHARMACY AND DISCOUNT CORP
Active
Other names
REDLAND PHARMACY DISCOUNT
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY RAYMOND (PRESIDENT)
(305) 378-6116
Entity
Organization
Contact information
Practice address
19752 SW 177TH AVE, MIAMI, FL 33187-2600
(305) 378-6116
(305) 378-4435
Mailing address
19752 SW 177TH AVE, MIAMI, FL 33187-2600
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1035408
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/27/2008
Last updated
03/20/2009
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