Provider Demographics
NPI:1669882627
Name:UNIVERSAL PHARMACY
Entity type:Organization
Organization Name:UNIVERSAL PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEJO SARDUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-657-3664
Mailing Address - Street 1:4888 NW 183RD ST
Mailing Address - Street 2:UNIT #105
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2900
Mailing Address - Country:US
Mailing Address - Phone:786-657-3476
Mailing Address - Fax:786-657-3280
Practice Address - Street 1:4888 NW 183RD ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2939
Practice Address - Country:US
Practice Address - Phone:786-657-3476
Practice Address - Fax:786-657-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
FLPH280793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145477OtherPK