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NPI Code Detail

MEDICARE: 305 RX LLC

MEDICARE: 305 RX LLC
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
13336C0003XCommunity/Retail PharmacyPH24536FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21055171OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760707806
Entity Type Code : Organization
Provider Name (Legal Business Name) : 305 RX LLC
Provider Business Mailing Address
First Line : 344 W 65TH ST
Second Line : #101
City : HIALEAH
State : FL
Zip : 33012-6719
Country : US
Telephone Number : 305-558-3522
Fax Number : 305-487-7409
Provider Business Practice Location Address
First Line : 344 W 65TH ST STE 101
Second Line :
City : HIALEAH
State : FL
Zip : 33012-6719
Country : US
Telephone Number : 305-558-3522
Fax Number : 305-487-7409
Authorized Official
Title or Position : OWNER
Name : VICTOR HERNANDEZ
Credential :
Telephone Number : 305-558-3522
Provider Enumeration Date : 04/01/2010
Last Update Date : 03/14/2012

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Directions to “305 RX LLC ” Practice Location

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