Healthcare Provider Details

I. General information

NPI: 1003227638
Provider Name (Legal Business Name): SCRIPT SHOP MIAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 MICHIGAN AVE 800
MIAMI BEACH FL
33139-2538
US

IV. Provider business mailing address

1680 MICHIGAN AVE 800
MIAMI BEACH FL
33139-2538
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-1601
  • Fax:
Mailing address:
  • Phone: 888-888-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SERGIO CARRENO
Title or Position: DIRECTOR
Credential:
Phone: 888-888-1601