Healthcare Provider Details

I. General information

NPI: 1669882627
Provider Name (Legal Business Name): UNIVERSAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 NW 183RD ST STE 105
MIAMI GARDENS FL
33055-2939
US

IV. Provider business mailing address

4888 NW 183RD ST UNIT #105
MIAMI GARDENS FL
33055-2900
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-3476
  • Fax: 786-657-3280
Mailing address:
  • Phone: 786-657-3476
  • Fax: 786-657-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28079
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAURICIO ALEJO SARDUY
Title or Position: OWNER
Credential:
Phone: 786-657-3664