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General NPI Number Information
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NPI Number | 1841779410
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Entity Type | Organization
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Legal Business Name | MA-GA FAMILY LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 2356 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33125-3249
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Country | US
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Telephone | 786-899-0912
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Fax | 786-238-7787
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Provider Business Mailing Address
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Address Line | 2356 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33125-3249
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Country | US
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Telephone | 786-899-0912
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Fax | 786-238-7787
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERNESTO VARONA
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Credential |
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Telephone | 786-899-0912
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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 | PH31568
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License Number State | FL
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