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NPI Code Detail

MEDICARE: WATED PHARMACY DISCOUNT INC

MEDICARE: WATED PHARMACY DISCOUNT 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
1333600000XPharmacyFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13845OTHERFLDOC NUMB

General Provider Information

NPI Number : 1164780516
Entity Type Code : Organization
Provider Name (Legal Business Name) : WATED PHARMACY DISCOUNT INC
Provider Business Mailing Address
First Line : 7130 SW 117TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33183-2809
Country : US
Telephone Number : 305-271-0131
Fax Number : 305-271-0131
Provider Business Practice Location Address
First Line : 7130 SW 117TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33183-2809
Country : US
Telephone Number : 305-271-0131
Fax Number : 305-271-0131
Authorized Official
Title or Position : PRESIDENT
Name : CAROLINA WATED
Credential :
Telephone Number : 305-271-0131
Provider Enumeration Date : 04/23/2012
Last Update Date : 04/23/2012

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Directions to “WATED PHARMACY DISCOUNT INC ” Practice Location

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