MEDICARE: UNITED 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	333600000X	Pharmacy	PH23642	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1042073	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1396982955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHARMACY & DISCOUNT INC

Provider Business Mailing Address
First Line	:	22177 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-2840
Country	:	US
Telephone Number	:	786-349-4576
Fax Number	:	786-349-4578

Provider Business Practice Location Address
First Line	:	12887 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3435
Country	:	US
Telephone Number	:	305-221-8699
Fax Number	:	305-221-1038

Authorized Official
Title or Position	:	OWNER
Name	:	ISMAEL BRUNET
Credential	:
Telephone Number	:	786-349-4576

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/30/2012

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