Prestab Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH19462 Issued in FL

Legal business name

PRESTAB CO

Practice address

3016 NW 79TH Ave
Doral, FL 33122-1010

Phone

(305) 599-1643

Fax

(305) 599-1663

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Alexis M. Basulto

Title

President

Phone

(305) 599-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730261033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 NW 79TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331221010",
            "telephone_number": "305-599-1643",
            "fax_number": "305-599-1663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3016 NW 79TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331221010",
            "telephone_number": "305-599-1643",
            "fax_number": "305-599-1663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTAB CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BASULTO",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-599-7000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH19462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02697010",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Doral, FL
• Providers in Doral, 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 Aug 22, 2020; 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.