MEDICARE: PINECREST PHARMACY, INC

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1063463883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINECREST PHARMACY, INC

Provider Business Mailing Address
First Line	:	955 NW 3RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33128-1274
Country	:	US
Telephone Number	:	305-253-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 NW 3RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33128-1274
Country	:	US
Telephone Number	:	305-253-9191
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESUS GAZQUEZ
Credential	:
Telephone Number	:	305-253-9191

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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Directions to “PINECREST PHARMACY, INC ” Practice Location

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