MEDICARE: MY DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy		FL

General Provider Information

NPI Number	:	1003228883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY DRUG STORE INC

Provider Business Mailing Address
First Line	:	1901 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-464-9549
Fax Number	:	786-353-2683

Provider Business Practice Location Address
First Line	:	1901 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1677
Country	:	US
Telephone Number	:	786-464-9549
Fax Number	:	786-353-2683

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIGUEL TEJERA
Credential	:
Telephone Number	:	786-464-9549

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	09/26/2014

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Directions to “MY DRUG STORE INC ” Practice Location

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