=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033406954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAIMY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2011
-----------------------------------------------------
Last Update Date | 06/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5080 E 4TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-431-1870
-----------------------------------------------------
Fax | 786-536-5017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5080 E 4TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-431-1870
-----------------------------------------------------
Fax | 786-536-5017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ARNALDO LLANES
-----------------------------------------------------
Credential | N/A
-----------------------------------------------------
Telephone | 786-431-1870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PH25545
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------