MEDICARE: YONG PHARMACY DISCOUNT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80840	OTHER	FL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1043263510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YONG PHARMACY DISCOUNT

Provider Business Mailing Address
First Line	:	2324 SW 67TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1846
Country	:	US
Telephone Number	:	786-388-4990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 SW 67TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1846
Country	:	US
Telephone Number	:	786-388-4990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANILO FONSECA
Credential	:
Telephone Number	:	786-388-4990

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/29/2009

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Directions to “YONG PHARMACY DISCOUNT ” Practice Location

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