Healthcare Provider Details

I. General information

NPI: 1003299967
Provider Name (Legal Business Name): CARESMART PHARMACY 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 SW 8TH ST SUITE 103
MIAMI FL
33135-2862
US

IV. Provider business mailing address

2955 SW 8TH ST SUITE 103
MIAMI FL
33135-2862
US

V. Phone/Fax

Practice location:
  • Phone: 305-972-8952
  • Fax:
Mailing address:
  • Phone: 305-972-8952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH29208
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH29211
License Number StateFL

VIII. Authorized Official

Name: YULIEN DIAZ GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 305-972-8959