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NPI Code Detail

MEDICARE: NORTHWEST MEDICAL PHARMACY LLC

MEDICARE: NORTHWEST MEDICAL PHARMACY LLC
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
1333600000XPharmacyPH25535FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25706392OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1083901938
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST MEDICAL PHARMACY LLC
Provider Business Mailing Address
First Line : 2089 SW 67TH AVE
Second Line : SUITE B
City : MIAMI
State : FL
Zip : 33155-1835
Country : US
Telephone Number : 305-637-6776
Fax Number : 305-637-3404
Provider Business Practice Location Address
First Line : 2089 SW 67TH AVE
Second Line : SUITE B
City : MIAMI
State : FL
Zip : 33155-1835
Country : US
Telephone Number : 305-637-6776
Fax Number : 305-637-3404
Authorized Official
Title or Position : MGRM
Name : ALEXEI TOLEDO
Credential :
Telephone Number : 305-637-6776
Provider Enumeration Date : 06/29/2011
Last Update Date : 02/14/2013

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Directions to “NORTHWEST MEDICAL PHARMACY LLC ” Practice Location

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