MEDICARE: PASTEUR MEDICAL MANAGEMENT, LLC

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	332900000X	Non-Pharmacy Dispensing Site	607581	FL

General Provider Information

NPI Number	:	1225578818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTEUR MEDICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	5900 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6025
Country	:	US
Telephone Number	:	305-722-8565
Fax Number	:	305-722-8561

Provider Business Practice Location Address
First Line	:	5900 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-6025
Country	:	US
Telephone Number	:	305-722-8565
Fax Number	:	786-722-8561

Authorized Official
Title or Position	:	SVP PHARMACY OPERATIONS & PART D
Name	:	MR. JUAN MORA
Credential	:
Telephone Number	:	305-448-8100

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	03/08/2017

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