MEDICARE: PASTEUR PHARMACY II, LLC

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	3336C0002X	Clinic Pharmacy	PH25135	FL

General Provider Information

NPI Number	:	1033421144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTEUR PHARMACY II, LLC

Provider Business Mailing Address
First Line	:	5900 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6025
Country	:	US
Telephone Number	:	305-722-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6025
Country	:	US
Telephone Number	:	305-722-8580
Fax Number	:	305-722-8563

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TARIK HAWATMEH
Credential	:
Telephone Number	:	786-422-6821

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	02/22/2017

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