=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730260514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXI-CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 N CONGRESS AVE STE 9
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-735-3300
-----------------------------------------------------
Fax | 561-735-3629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 N CONGRESS AVE STE 9
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-735-3300
-----------------------------------------------------
Fax | 561-735-3629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MR. RAUL JULIO ARAGON
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 561-735-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH0013250
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------