MEDICARE: SAN JUAN 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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1578926135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN JUAN PHARMACY LLC

Provider Business Mailing Address
First Line	:	9533 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4035
Country	:	US
Telephone Number	:	305-399-7449
Fax Number	:

Provider Business Practice Location Address
First Line	:	9533 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4035
Country	:	US
Telephone Number	:	305-399-7449
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YANET RODRIGUEZ ANDINO
Credential	:
Telephone Number	:	305-399-7449

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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Directions to “SAN JUAN PHARMACY LLC ” Practice Location

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