MEDICARE: EKG PHARMACY 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
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1902237340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EKG PHARMACY LLC

Provider Business Mailing Address
First Line	:	7305 NW 36TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-6704
Country	:	US
Telephone Number	:	305-592-8557
Fax Number	:	305-592-8558

Provider Business Practice Location Address
First Line	:	7305 NW 36TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-6704
Country	:	US
Telephone Number	:	305-592-8557
Fax Number	:	305-592-8558

Authorized Official
Title or Position	:	MANAGER
Name	:	ELENA DOSAL
Credential	:
Telephone Number	:	305-592-8557

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	12/11/2013

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Directions to “EKG PHARMACY LLC ” Practice Location

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