MEDICARE: AJ PHARMACY CORP

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	:	1376968479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJ PHARMACY CORP

Provider Business Mailing Address
First Line	:	4615 NW 72ND AVE
Second Line	:	UNIT 115
City	:	MIAMI
State	:	FL
Zip	:	33166-5689
Country	:	US
Telephone Number	:	305-477-7585
Fax Number	:	305-477-7588

Provider Business Practice Location Address
First Line	:	4615 NW 72ND AVE
Second Line	:	UNIT 115
City	:	MIAMI
State	:	FL
Zip	:	33166-5689
Country	:	US
Telephone Number	:	305-477-7585
Fax Number	:	305-477-7588

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZAYONARA CHACON
Credential	:
Telephone Number	:	305-477-7585

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	04/23/2014

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Directions to “AJ PHARMACY CORP ” Practice Location

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