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NPI Code Detail

MEDICARE: ST JUDE PHARMACY & DISCOUNT INC

MEDICARE: ST JUDE 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
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail PharmacyPH25424FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12133928OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205128774
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JUDE PHARMACY & DISCOUNT INC
Provider Business Mailing Address
First Line : 4822 NW 167TH ST
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33014-6426
Country : US
Telephone Number : 305-621-3448
Fax Number : 305-621-3464
Provider Business Practice Location Address
First Line : 4822 NW 167TH ST
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33014-6426
Country : US
Telephone Number : 305-621-3448
Fax Number : 305-621-3464
Authorized Official
Title or Position : PRESIDENT
Name : JUAN HERNANDEZ
Credential :
Telephone Number : 305-621-3448
Provider Enumeration Date : 05/03/2011
Last Update Date : 04/28/2017

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Directions to “ST JUDE PHARMACY & DISCOUNT INC ” Practice Location

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