MEDICARE: PHARMACIA SELO 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1760481980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACIA SELO INC

Provider Business Mailing Address
First Line	:	5989 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5037
Country	:	US
Telephone Number	:	305-265-3738
Fax Number	:	305-265-1872

Provider Business Practice Location Address
First Line	:	5989 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5037
Country	:	US
Telephone Number	:	305-265-3738
Fax Number	:	305-265-1872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARDO RIVERO
Credential	:
Telephone Number	:	305-265-3738

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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