Healthcare Provider Details

I. General information

NPI: 1881770139
Provider Name (Legal Business Name): MELI PHARMACY & SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 EAST 4TH AVE
HIALEAH FL
33010
US

IV. Provider business mailing address

1432 EAST 4TH AVE
HIALEAH FL
33010
US

V. Phone/Fax

Practice location:
  • Phone: 305-863-7211
  • Fax: 305-863-7249
Mailing address:
  • Phone: 305-863-7211
  • Fax: 305-863-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH20954
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH 20954
License Number StateFL

VIII. Authorized Official

Name: MR. ELIADES PENA ALCOLEA
Title or Position: OWNER PRESIDENT
Credential:
Phone: 305-863-7211