MEDICARE: VERSALLES PHARMACY 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	PH26463	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143175	OTHER		PK

General Provider Information

NPI Number	:	1275963456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSALLES PHARMACY INC

Provider Business Mailing Address
First Line	:	3526 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1028
Country	:	US
Telephone Number	:	305-456-7333
Fax Number	:	305-456-3938

Provider Business Practice Location Address
First Line	:	3526 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-1028
Country	:	US
Telephone Number	:	305-456-7333
Fax Number	:	305-456-3938

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARTURO PAEZ
Credential	:
Telephone Number	:	305-456-7333

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	02/13/2014

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Directions to “VERSALLES PHARMACY INC ” Practice Location

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