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General NPI Number Information
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NPI Number | 1972659472
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Entity Type | Organization
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Legal Business Name | JMG PHARMACY, INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 3750 W 16TH AVE SUITE 100
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-822-2351
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 W 16TH AVE SUITE 100
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-822-2351
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN CARLOS GONZALEZ
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Credential |
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Telephone | 305-822-2351
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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 | PH22465
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License Number State | FL
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