=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740557461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYAR PHARMACY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2011
-----------------------------------------------------
Last Update Date | 11/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12910 SW 133RD CT SUITE A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-6584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-251-3635
-----------------------------------------------------
Fax | 305-251-3536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12910 SW 133RD CT SUITE A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-6584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-251-3635
-----------------------------------------------------
Fax | 305-251-3536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MADELIN MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-251-3635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | PH25786
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------