=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750770236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2015
-----------------------------------------------------
Last Update Date | 01/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7413 MIAMI LAKES DR SUITE B
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-6818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-971-4339
-----------------------------------------------------
Fax | 305-821-4338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7413 MIAMI LAKES DR SUITE B
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-971-4339
-----------------------------------------------------
Fax | 305-821-4338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FADY GIRGIS
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 888-971-4339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | PH27199
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------