MEDICARE: PROF. JOSE CARLOS MORALES 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	PS26289	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS 26289	OTHER	FL	PHARMACIST LICENSEE

General Provider Information

NPI Number	:	1760519235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JOSE CARLOS MORALES RPH

Provider Business Mailing Address
First Line	:	8465 SW 76TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-3750
Country	:	US
Telephone Number	:	786-303-5501
Fax Number	:	305-558-1515

Provider Business Practice Location Address
First Line	:	5945 W 25TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4423
Country	:	US
Telephone Number	:	305-558-7800
Fax Number	:	305-558-1515

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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