Healthcare Provider Details

I. General information

NPI: 1366837130
Provider Name (Legal Business Name): 49TH STREET PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E 49TH ST
HIALEAH FL
33013-1867
US

IV. Provider business mailing address

455 E 49TH ST
HIALEAH FL
33013-1867
US

V. Phone/Fax

Practice location:
  • Phone: 786-483-8843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. OYEJIDE AKANBI
Title or Position: OWNER
Credential: PHARM.D
Phone: 786-483-8843