Grey Dog IV, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH31442 Issued in FL

Legal business name

GREY DOG IV, INC

Doing business as

Ethos Wellness Pharmacy

Practice address

260 Crandon Blvd Ste 33
Key Biscayne, FL 33149-1538

Phone

(305) 982-8727

NPI assigned

Jul 18, 2018

Last updated

Jul 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rafael Parra, RPT, CPHT

Title

Treasurer

Phone

(305) 781-7768

Specialties & licenses 1

Addresses

Other names 1

• Ethos Wellness Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• HealthSun Health Plans Network

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Javier Diaz, PHARMD

  • Pharmacist
  • Miami Beach, FL
  • NPI 1932463239
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1275019705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 CRANDON BLVD STE 33",
            "city": "KEY BISCAYNE",
            "state": "FL",
            "postal_code": "331491538",
            "telephone_number": "305-982-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 CRANDON BLVD STE 33",
            "city": "KEY BISCAYNE",
            "state": "FL",
            "postal_code": "331491538",
            "telephone_number": "305-982-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREY DOG IV, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "PARRA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "305-781-7768",
        "authorized_official_credential": "RPT, CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH31442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ethos Wellness Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Guillermina Giardinelli, LMFT
• Chloe Marie Godward, LMFT
• Roland Manuel Gracia, M.D.
• Graciela C Pozo Mdpa
• Stephanie Grail, MD
• Ramon A Guevara, DO
• Mae Gutierrez, M.D.
• Natalie Suzanne Guzman, DPT
• Valentina Heinz
• Hernandez Lea Plaza Dental

• Community/Retail Pharmacy in Key Biscayne, FL
• Providers in Key Biscayne, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.