MEDICARE: BAPTIST PHARMACY NORTH 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	PH26832	FL

General Provider Information

NPI Number	:	1780021121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST PHARMACY NORTH INC

Provider Business Mailing Address
First Line	:	1187 WEST 35 ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-827-0738
Fax Number	:	305-827-0739

Provider Business Practice Location Address
First Line	:	1187 WEST 35 STREET
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-827-0738
Fax Number	:	305-827-0739

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YORDANKA PEREZ
Credential	:
Telephone Number	:	786-391-3710

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	04/22/2015

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