Provider Demographics
NPI:1366750473
Name:KEZIT DISCOUNT PHARMACY
Entity type:Organization
Organization Name:KEZIT DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:ONWUANA
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-301-4563
Mailing Address - Street 1:12813 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4807
Mailing Address - Country:US
Mailing Address - Phone:305-456-6844
Mailing Address - Fax:305-456-5854
Practice Address - Street 1:12813 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4807
Practice Address - Country:US
Practice Address - Phone:305-456-6844
Practice Address - Fax:305-456-5854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEZIT MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH249053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy