Healthcare Provider Details

I. General information

NPI: 1982452264
Provider Name (Legal Business Name): XCELLENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 SW 40TH ST STE 119
MIAMI FL
33175-3573
US

IV. Provider business mailing address

11880 SW 40TH ST STE 119
MIAMI FL
33175-3573
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-1496
  • Fax:
Mailing address:
  • Phone: 305-229-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AYMED GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-229-1496