MEDICARE: MIAMI DADE PHARMACY DISCOUNT INC

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	PH26422	FL

General Provider Information

NPI Number	:	1720331168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI DADE PHARMACY DISCOUNT INC

Provider Business Mailing Address
First Line	:	2168 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3425
Country	:	US
Telephone Number	:	305-643-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2168 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3425
Country	:	US
Telephone Number	:	305-643-4720
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDGAR DELGADO
Credential	:
Telephone Number	:	786-355-1850

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	10/23/2012

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