Organization
GOODYEAR DISCOUNT PHARMACY
Active
Other names
GOODYEAR DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE HERNANDEZ (PRESIDENT)
(305) 884-0868
Entity
Organization
Contact information
Practice address
272 W 21ST ST, HIALEAH, FL 33010-2517
(305) 884-0868
(305) 884-0869
Mailing address
272 W 21ST ST, HIALEAH, FL 33010-2517
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23101
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032527
OTHER ID NUMBER
—
Enumeration date
02/12/2008
Last updated
02/12/2008
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