MEDICARE: #1 RX LIBERTY PHARMACY DISCOUNT CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy		FL

General Provider Information

NPI Number	:	1003098971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	#1 RX LIBERTY PHARMACY DISCOUNT CORP

Provider Business Mailing Address
First Line	:	972 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	305-691-6686
Fax Number	:	305-691-6682

Provider Business Practice Location Address
First Line	:	972 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	305-691-6686
Fax Number	:	305-691-6682

Authorized Official
Title or Position	:	OWNER
Name	:	PEDRO PABLO ROSADO
Credential	:
Telephone Number	:	305-691-6686

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	05/06/2010

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