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NPI Code Detail

MEDICARE: PRICE CHOICE PHARMACY 2

MEDICARE: PRICE CHOICE PHARMACY 2
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
1333600000XPharmacyPH25613FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15707572OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1407135890
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRICE CHOICE PHARMACY 2
Provider Business Mailing Address
First Line : 4500 NW 183RD ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33055-3045
Country : US
Telephone Number : 305-517-1412
Fax Number : 305-851-3104
Provider Business Practice Location Address
First Line : 4500 NW 183RD ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33055-3045
Country : US
Telephone Number : 305-517-1412
Fax Number : 305-851-3104
Authorized Official
Title or Position : MANAGING MEMBER
Name : EMERSON MOLINA
Credential :
Telephone Number : 305-517-1412
Provider Enumeration Date : 08/16/2011
Last Update Date : 10/08/2012

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Directions to “PRICE CHOICE PHARMACY 2 ” Practice Location

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