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General NPI Number Information
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NPI Number | 1801801410
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Entity Type | Organization
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Legal Business Name | COUNTRY WALK PHARMACY
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1845 NW 17TH AVE
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City | MIAMI
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State | FL
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Zip | 33125-2330
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Country | US
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Telephone | 305-325-0301
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Fax | 305-278-7600
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Provider Business Mailing Address
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Address Line | 1845 NW 17TH AVE
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City | MIAMI
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State | FL
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Zip | 33125-2330
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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 | ADMIN
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Name | ELSA RUIZ
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Credential |
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Telephone | 305-325-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH21332
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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 |
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License Number State |
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