MEDICARE: CHOBEE PHARMACY LLC

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	:	1346655818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOBEE PHARMACY LLC

Provider Business Mailing Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-391-4314
Fax Number	:	786-391-4609

Provider Business Practice Location Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-391-4314
Fax Number	:	786-391-4609

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERNESTO REYES
Credential	:
Telephone Number	:	786-391-4314

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	08/14/2014

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