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NPI Code Detail

MEDICARE: NINA PHARMACY, INC

MEDICARE: NINA 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
13336C0003XCommunity/Retail PharmacyPH23276FL

General Provider Information

NPI Number : 1174795686
Entity Type Code : Organization
Provider Name (Legal Business Name) : NINA PHARMACY, INC
Provider Business Mailing Address
First Line : 4228 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-7624
Country : US
Telephone Number : 305-558-0740
Fax Number : 305-558-0741
Provider Business Practice Location Address
First Line : 4228 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-7624
Country : US
Telephone Number : 305-558-0740
Fax Number : 305-558-0741
Authorized Official
Title or Position : PRESIDENT
Name : LUIS BENITEZ
Credential :
Telephone Number : 305-558-0740
Provider Enumeration Date : 03/25/2008
Last Update Date : 08/01/2008

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