MEDICARE: GLA 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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619674819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLA PHARMACY, LLC

Provider Business Mailing Address
First Line	:	4700 NW 7TH ST STE 1
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2252
Country	:	US
Telephone Number	:	305-640-5764
Fax Number	:	305-640-5149

Provider Business Practice Location Address
First Line	:	4700 NW 7TH ST STE 1
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2252
Country	:	US
Telephone Number	:	305-640-5764
Fax Number	:	305-640-5149

Authorized Official
Title or Position	:	PHARMACIST
Name	:	GLEYVYS RODRIGUEZ
Credential	:	PHARMD
Telephone Number	:	786-925-7436

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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