MEDICARE: PHARMA-PLUS DRUG STORE CORP

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	333600000X	Pharmacy	PH19903	FL

General Provider Information

NPI Number	:	1750378394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMA-PLUS DRUG STORE CORP

Provider Business Mailing Address
First Line	:	619 SW 57TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-3970
Country	:	US
Telephone Number	:	305-262-3738
Fax Number	:	305-265-3730

Provider Business Practice Location Address
First Line	:	619 SW 57TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-3970
Country	:	US
Telephone Number	:	305-262-3738
Fax Number	:	305-265-3730

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAULA FONG
Credential	:
Telephone Number	:	305-262-3738

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/22/2020

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Directions to “PHARMA-PLUS DRUG STORE CORP ” Practice Location

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