MEDICARE: APPLE PHARMACY DISCOUNT 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	PH25987	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5709475	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1861767840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE PHARMACY DISCOUNT INC

Provider Business Mailing Address
First Line	:	2730 NW 22ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-8433
Country	:	US
Telephone Number	:	305-636-2888
Fax Number	:	305-636-5080

Provider Business Practice Location Address
First Line	:	2730 NW 22ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-8433
Country	:	US
Telephone Number	:	305-636-2888
Fax Number	:	305-636-5080

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MARISELA DE LEON
Credential	:
Telephone Number	:	305-636-2888

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/29/2013

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Directions to “APPLE PHARMACY DISCOUNT INC ” Practice Location

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