Healthcare Provider Details

I. General information

NPI: 1154628097
Provider Name (Legal Business Name): MIAMI EXECUTIVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 74TH CT STE 102
MIAMI FL
33156-3172
US

IV. Provider business mailing address

8950 SW 74TH CT SUITE 102
MIAMI FL
33156-3171
US

V. Phone/Fax

Practice location:
  • Phone: 305-670-5253
  • Fax: 800-557-0966
Mailing address:
  • Phone: 305-670-5253
  • Fax: 800-557-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25241
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREY SOLOVYEV
Title or Position: PRESIDENT
Credential:
Phone: 305-670-5253