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General NPI Number Information
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NPI Number | 1790055382
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Entity Type | Organization
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Legal Business Name | PALM AVE PHARMACY DISCOUNT CORPORATION
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1301 PALM AVE UNIT 105
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City | HIALEAH
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State | FL
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Zip | 33010-3461
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Country | US
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Telephone | 305-887-7979
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Fax | 305-887-7909
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Provider Business Mailing Address
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Address Line | 1301 PALM AVE STE #105
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City | HIALEAH
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State | FL
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Zip | 33010-3463
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Country | US
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Telephone | 305-887-7979
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Fax | 305-887-7909
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAYKEL MACHADO
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Credential |
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Telephone | 786-287-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25882
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License Number State | FL
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