MEDICARE: XIMENA SUSANA PACHECO-VELIZ RPH

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	PS39618	FL

General Provider Information

NPI Number	:	1699911479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIMENA SUSANA PACHECO-VELIZ RPH

Provider Business Mailing Address
First Line	:	2601 SOUTH MILITARY TRAIL
Second Line	:	SUITE 25
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7510
Country	:	US
Telephone Number	:	561-660-7869
Fax Number	:	561-660-7879

Provider Business Practice Location Address
First Line	:	2601 S MILITARY TRL STE 25
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7512
Country	:	US
Telephone Number	:	561-660-7869
Fax Number	:	561-660-7879

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

Provider Enumeration Date	:	12/27/2008
Last Update Date	:	11/07/2017

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