MEDICARE: MARIANNA CHAMIZO

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	183500000X	Pharmacist	PS52206	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS52206	OTHER	FL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1649673948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNA CHAMIZO

Provider Business Mailing Address
First Line	:	920 NW 123RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-2411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 NW 123RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-2411
Country	:	US
Telephone Number	:	305-389-5735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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Directions to “ MARIANNA CHAMIZO ” Practice Location

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