MEDICARE: KEZIT DISCOUNT PHARMACY

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	PH24905	FL

General Provider Information

NPI Number	:	1366750473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEZIT DISCOUNT PHARMACY

Provider Business Mailing Address
First Line	:	12813 W DIXIE HWY
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-4807
Country	:	US
Telephone Number	:	305-456-6844
Fax Number	:	305-456-5854

Provider Business Practice Location Address
First Line	:	12813 W DIXIE HWY
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-4807
Country	:	US
Telephone Number	:	305-456-6844
Fax Number	:	305-456-5854

Authorized Official
Title or Position	:	PHARMACIST
Name	:	FABIAN ONWUANA IGWE
Credential	:
Telephone Number	:	786-301-4563

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/30/2010

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Directions to “KEZIT DISCOUNT PHARMACY ” Practice Location

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