MEDICARE: MY SUPER PHARMACY

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

General Provider Information

NPI Number	:	1689440810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY SUPER PHARMACY

Provider Business Mailing Address
First Line	:	10550 NW 77TH CT STE 303
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	786-485-4170
Fax Number	:	786-485-4845

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT STE 303
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2071
Country	:	US
Telephone Number	:	786-485-4170
Fax Number	:	786-485-4845

Authorized Official
Title or Position	:	PRES
Name	:	RUBY FERRER
Credential	:
Telephone Number	:	786-546-5144

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	02/05/2026

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Directions to “MY SUPER PHARMACY ” Practice Location

Language	Start Address	Practice Location

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