MEDICARE: DNA 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
1	3336C0003X	Community/Retail Pharmacy		FL

General Provider Information

NPI Number	:	1235544305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNA PHARMACY INC

Provider Business Mailing Address
First Line	:	347 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4715
Country	:	US
Telephone Number	:	786-362-6263
Fax Number	:	786-362-6263

Provider Business Practice Location Address
First Line	:	347 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4715
Country	:	US
Telephone Number	:	786-362-6263
Fax Number	:	786-362-6263

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KERLYN SORIA
Credential	:
Telephone Number	:	786-362-6263

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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