MEDICARE: JUAN ANTONIO PAULA RPH

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	183500000X	Pharmacist	PS24638	FL

General Provider Information

NPI Number	:	1306114368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN ANTONIO PAULA RPH

Provider Business Mailing Address
First Line	:	2614 NE 10TH CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33033-4712
Country	:	US
Telephone Number	:	305-242-0377
Fax Number	:	305-242-0410

Provider Business Practice Location Address
First Line	:	2614 NE 10TH CT
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33033-4712
Country	:	US
Telephone Number	:	305-242-0377
Fax Number	:	305-242-0410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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Directions to “ JUAN ANTONIO PAULA RPH” Practice Location

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