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General NPI Number Information
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NPI Number | 1821213133
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Entity Type | Organization
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Legal Business Name | JERRY PHARMACY AND MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 3855 SW 137TH AVE 13
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City | MIAMI
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State | FL
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Zip | 33175-8820
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Country | US
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Telephone | 305-225-5007
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Fax | 305-225-5008
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Provider Business Mailing Address
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Address Line | 3855 SW 137TH AVE 13
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City | MIAMI
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State | FL
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Zip | 33175-8820
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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 | PRESIDENT
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Name | JULIO BRUNET
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Credential |
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Telephone | 305-225-5007
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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 | PH22524
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License Number State | FL
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