Basic Information
| Provider Information | |||||||||
| NPI: | 1255799854 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMFORT PHARMACY 2, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMFORT PHARMACY 2 CORP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9725 NW 117TH AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MEDLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544320578 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Practice Location | |||||||||
| Address1: | 12600 SW 120TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331869115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865477423 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | MARLOW | ||||||||
| AuthorizedOfficialMiddleName: | BLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9545149360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.