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NPI Code Detail

MEDICARE: POLARIS PHARMACY CORP

MEDICARE: POLARIS PHARMACY 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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPH17233FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11089766OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366508251
Entity Type Code : Organization
Provider Name (Legal Business Name) : POLARIS PHARMACY CORP
Provider Business Mailing Address
First Line : 10845 SW 40TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33165-4410
Country : US
Telephone Number : 305-485-8787
Fax Number : 305-554-6320
Provider Business Practice Location Address
First Line : 10845 SW 40TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33165-4410
Country : US
Telephone Number : 305-485-8787
Fax Number : 305-554-6320
Authorized Official
Title or Position : PRESIDENT
Name : YADER PADILLA
Credential :
Telephone Number : 305-485-8787
Provider Enumeration Date : 12/28/2006
Last Update Date : 06/16/2010

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Directions to “POLARIS PHARMACY CORP ” Practice Location

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