Healthcare Provider Details

I. General information

NPI: 1215329875
Provider Name (Legal Business Name): MELRICK PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 E 9TH ST
HIALEAH FL
33010-4549
US

IV. Provider business mailing address

557 E 9TH ST
HIALEAH FL
33010-4549
US

V. Phone/Fax

Practice location:
  • Phone: 786-534-9535
  • Fax: 786-534-9533
Mailing address:
  • Phone: 786-534-9535
  • Fax: 786-534-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28753
License Number StateFL

VIII. Authorized Official

Name: MAYTE FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-534-9535