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General NPI Number Information
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NPI Number | 1770007486
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Entity Type | Organization
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Legal Business Name | MILLENIUM CLINIC PHARMACY INC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 12914 SW 133RD CT STE B
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City | MIAMI
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State | FL
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Zip | 33186-6585
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Country | US
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Telephone | 786-301-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 12914 SW 133RD CT STE B
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City | MIAMI
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State | FL
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Zip | 33186-6585
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER / PIC
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Name | SHEREEN H ABDOH
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Credential |
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Telephone | 786-301-5407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PH30847
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH30847
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License Number State | FL
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