Country Club Pharmacy & Discount Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PH26903 Issued in FL

Legal business name

COUNTRY CLUB PHARMACY & DISCOUNT INC

Practice address

5911 NW 173Rd Dr
# 6
Hialeah, FL 33015-5121

Phone

(305) 828-8600

Fax

(305) 828-8630

NPI assigned

Jul 17, 2013

Organization subpart

No

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

Authorized official

Name

Daisy Martinez

Title

President

Phone

(305) 828-8600

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Country Club Pharmacy and Discount Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Country Club Pharmacy and Discount Inc

  • Community/Retail Pharmacy
  • Hialeah, FL
  • NPI 1356641559
  NPD tax ID

Locations

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1447691555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 NW 173RD DR",
            "address_2": "# 6",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330155121",
            "telephone_number": "305-828-8600",
            "fax_number": "305-828-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5911 NW 173RD DR",
            "address_2": "# 6",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330155121",
            "telephone_number": "305-828-8600",
            "fax_number": "305-828-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB PHARMACY & DISCOUNT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "DAISY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-828-8600"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "FL",
            "license": "PH26903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NUMB",
            "identifier": "3719",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Costero, PSY. D
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• Country Club Pharmacy and Discount Inc
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• Bobby Concepcion Couto, PTA
• Covadonga Care Services, Inc.
• Covadonga Care Services, Inc.

• Long Term Care Pharmacy in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Long Term Care Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.