=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740552116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZAHRA PHARMACY & DISCOUNT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2012
-----------------------------------------------------
Last Update Date | 02/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12486 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-221-5600
-----------------------------------------------------
Fax | 305-221-9919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12486 SW 8TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-221-5600
-----------------------------------------------------
Fax | 305-221-9919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT /OWNER
-----------------------------------------------------
Name | FELIX IKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-221-5600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH25920
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------