Healthcare Provider Details

I. General information

NPI: 1962561993
Provider Name (Legal Business Name): JORGE MADERA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 22ND AVE
MIAMI FL
33142-8429
US

IV. Provider business mailing address

14630 BULL RUN RD APT 109
MIAMI LAKES FL
33014-2016
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-3000
  • Fax:
Mailing address:
  • Phone: 305-439-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: