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NPI Code Detail

MEDICARE: PINES PHARMACY INC

MEDICARE: PINES 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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacyPH25280FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15707382OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1326320961
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINES PHARMACY INC
Provider Business Mailing Address
First Line : 881 E 2ND AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33010-4205
Country : US
Telephone Number : 305-889-0377
Fax Number : 305-882-1162
Provider Business Practice Location Address
First Line : 881 E 2ND AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33010-4205
Country : US
Telephone Number : 305-889-0377
Fax Number : 305-882-1162
Authorized Official
Title or Position : PRESIDENT
Name : FRANCISCO BOZA
Credential :
Telephone Number : 305-889-0377
Provider Enumeration Date : 09/09/2011
Last Update Date : 10/19/2011

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Directions to “PINES PHARMACY INC ” Practice Location

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