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NPI Code Detail

MEDICARE: MIA PHARMACY DISCOUNT CORP

MEDICARE: MIA PHARMACY DISCOUNT CORP
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 PharmacyPH23367FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11035472OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1295902757
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIA PHARMACY DISCOUNT CORP
Provider Business Mailing Address
First Line : 33 NW 27TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33125-5111
Country : US
Telephone Number : 305-643-8078
Fax Number : 305-643-8079
Provider Business Practice Location Address
First Line : 33 NW 27TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33125-5111
Country : US
Telephone Number : 305-643-8078
Fax Number : 305-643-8079
Authorized Official
Title or Position : PRESIDENT
Name : JOEL MARTINEZ
Credential :
Telephone Number : 305-643-8078
Provider Enumeration Date : 05/14/2008
Last Update Date : 09/26/2008

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Directions to “MIA PHARMACY DISCOUNT CORP ” Practice Location

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