MEDICARE: WEST OKEECHOBEE 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
1	333600000X	Pharmacy		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4815	OTHER	FL	DOC NUMBER

General Provider Information

NPI Number	:	1376838409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OKEECHOBEE PHARMACY INC

Provider Business Mailing Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-558-9150
Fax Number	:	786-558-9151

Provider Business Practice Location Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-558-9150
Fax Number	:	786-558-9151

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARDO BELLO
Credential	:
Telephone Number	:	786-558-9150

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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