MEDICARE: DR. MELISSA JIMENEZ PHARMD

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	183500000X	Pharmacist	PS46914	FL

General Provider Information

NPI Number	:	1093445322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA JIMENEZ PHARMD

Provider Business Mailing Address
First Line	:	905 W 39TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7244
Country	:	US
Telephone Number	:	305-308-6418
Fax Number	:

Provider Business Practice Location Address
First Line	:	9537 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3247
Country	:	US
Telephone Number	:	305-279-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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