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NPI Code Detail

MEDICARE: CORAL GABLES PHARMACY AND MEDICAL SUPPLY, INC

MEDICARE: CORAL GABLES PHARMACY AND MEDICAL SUPPLY, 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0004XCompounding Pharmacy
43336M0002XMail Order Pharmacy
53336C0003XCommunity/Retail PharmacyPH25066FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15702786OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1063714111
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORAL GABLES PHARMACY AND MEDICAL SUPPLY, INC
Provider Business Mailing Address
First Line : 3160 PONCE DE LEON BLVD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-6826
Country : US
Telephone Number : 305-444-5115
Fax Number : 305-444-5119
Provider Business Practice Location Address
First Line : 3160 PONCE DE LEON BLVD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-6826
Country : US
Telephone Number : 305-444-5115
Fax Number : 305-444-5119
Authorized Official
Title or Position : PHARMACY MANAGER
Name : RICARDO PAEZ
Credential :
Telephone Number : 305-444-5115
Provider Enumeration Date : 11/23/2010
Last Update Date : 11/23/2010

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Directions to “CORAL GABLES PHARMACY AND MEDICAL SUPPLY, INC ” Practice Location

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