MEDICARE: KIARA DISCOUNT PHARMACY COR

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1982918512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIARA DISCOUNT PHARMACY COR

Provider Business Mailing Address
First Line	:	9620 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3250
Country	:	US
Telephone Number	:	786-201-4666
Fax Number	:	305-477-6518

Provider Business Practice Location Address
First Line	:	9620 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3250
Country	:	US
Telephone Number	:	786-201-4666
Fax Number	:	305-477-6518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JESUS FUNDORA
Credential	:
Telephone Number	:	786-201-4666

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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