MEDICARE: COUNTRY WALK PHARMACY & DISCOUNT 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

General Provider Information

NPI Number	:	1376557660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY WALK PHARMACY & DISCOUNT INC

Provider Business Mailing Address
First Line	:	1845 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2330
Country	:	US
Telephone Number	:	305-325-0301
Fax Number	:	305-325-9107

Provider Business Practice Location Address
First Line	:	1845 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2330
Country	:	US
Telephone Number	:	305-325-0301
Fax Number	:	305-325-9107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICIA MORCATE
Credential	:
Telephone Number	:	305-325-0301

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/27/2007

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