Healthcare Provider Details

I. General information

NPI: 1770625683
Provider Name (Legal Business Name): ASC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 W 84TH ST 108
HIALEAH FL
33018-4933
US

IV. Provider business mailing address

3416 W 84TH ST 108
HIALEAH FL
33018-4933
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-5411
  • Fax: 305-698-5586
Mailing address:
  • Phone: 305-698-5411
  • Fax: 305-698-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22490
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH22490
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH22490
License Number StateFL

VIII. Authorized Official

Name: ASCANIO SERNA
Title or Position: PRESIDENT
Credential:
Phone: 305-698-5411