Healthcare Provider Details

I. General information

NPI: 1811034119
Provider Name (Legal Business Name): MALECON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 W 16TH AVE
HIALEAH FL
33012-6814
US

IV. Provider business mailing address

5966 W 16TH AVE
HIALEAH FL
33012-6814
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-8551
  • Fax: 305-558-8512
Mailing address:
  • Phone: 305-558-8551
  • Fax: 305-558-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH6079
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREY SOLOVYEV
Title or Position: PRESIDENT
Credential:
Phone: 305-558-8551