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General NPI Number Information
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NPI Number | 1669564878
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Entity Type | Organization
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Legal Business Name | MILLER FOOD STORE INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14655 SW 56 STREET
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 305-388-1799
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Fax | 305-388-2393
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Provider Business Mailing Address
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Address Line | 14655 SW 56 STREET
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 305-388-1799
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Fax | 305-388-2393
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEO CUERVO
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Credential | RPH
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Telephone | 305-827-9582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH0019468
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License Number State | FL
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