=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922314509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIA ANGELICA PHARMACY & DISCOUNT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2010
-----------------------------------------------------
Last Update Date | 10/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11355 W FLAGLER ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-8088
-----------------------------------------------------
Fax | 305-222-8087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11355 W FLAGLER ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-1196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-8088
-----------------------------------------------------
Fax | 305-222-8087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARIA ANGELICA AMADOR
-----------------------------------------------------
Credential | CPHT
-----------------------------------------------------
Telephone | 305-222-8088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------