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General NPI Number Information
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NPI Number | 1245316272
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Entity Type | Organization
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Legal Business Name | MY PHARMACY OF BIRD ROAD
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 4000 SW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-5318
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Country | US
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Telephone | 305-666-8582
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Fax | 305-666-9110
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Provider Business Mailing Address
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Address Line | 4000 SW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-5318
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Country | US
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Telephone | 305-666-8582
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Fax | 305-666-9110
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AURELIO J. COLLAZO
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Credential | R.PH.
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Telephone | 305-666-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH28703
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH28703
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License Number State | FL
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