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NPI Code Detail

MEDICARE: NORTHWEST MEDICAL PHARMACY

MEDICARE: NORTHWEST MEDICAL PHARMACY
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
1333600000XPharmacy
23336L0003XLong Term Care PharmacyPH24054FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11053432OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1073757852
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST MEDICAL PHARMACY
Provider Business Mailing Address
First Line : 671 NW 119TH ST
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33168-2522
Country : US
Telephone Number : 954-582-3602
Fax Number : 866-396-9179
Provider Business Practice Location Address
First Line : 671 NW 119TH ST
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33168-2522
Country : US
Telephone Number : 954-582-3602
Fax Number : 866-396-9179
Authorized Official
Title or Position : OFFICER
Name : ERNESTO DIAZ
Credential :
Telephone Number : 305-651-7074
Provider Enumeration Date : 04/24/2009
Last Update Date : 02/17/2012

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Directions to “NORTHWEST MEDICAL PHARMACY ” Practice Location

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