MEDICARE: OKEECHOBEE DISCOUNT, CORPORATION

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	PH15857	FL

General Provider Information

NPI Number	:	1295830446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKEECHOBEE DISCOUNT, CORPORATION

Provider Business Mailing Address
First Line	:	1545 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	305-885-5577
Fax Number	:	305-885-8308

Provider Business Practice Location Address
First Line	:	1545 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	305-885-5577
Fax Number	:	305-885-8308

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUAN ESPANOLA
Credential	:
Telephone Number	:	305-885-5577

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/20/2009

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