Healthcare Provider Details

I. General information

NPI: 1225578818
Provider Name (Legal Business Name): PASTEUR MEDICAL MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 NW 183RD ST
MIAMI GARDENS FL
33015-6025
US

IV. Provider business mailing address

5900 NW 183RD ST
MIAMI GARDENS FL
33015-6025
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-8565
  • Fax: 786-722-8561
Mailing address:
  • Phone: 305-722-8565
  • Fax: 305-722-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number607581
License Number StateFL

VIII. Authorized Official

Name: MR. JUAN MORA
Title or Position: SVP PHARMACY OPERATIONS & PART D
Credential:
Phone: 305-448-8100