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General NPI Number Information
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NPI Number | 1326045345
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Entity Type | Organization
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Legal Business Name | THE MEDICARE SHOPPE INCORPORATED
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3013 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-3210
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Country | US
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Telephone | 305-693-3544
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Fax | 305-693-3519
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Provider Business Mailing Address
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Address Line | 3013 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-3210
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Country | US
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Telephone | 305-693-3544
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Fax | 305-693-3519
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Authorized Official
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Title or Position | PRESIDENT / PROGRAM DIRECTOR
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Name | MR. LUIS ANDRES FERNANDEZ
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Credential | CERTIFIED ORTHOTIST
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Telephone | 305-693-3544
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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 | PH16014
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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 | 1222810001
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License Number State | FL
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