MEDICARE: BERLINE AUGUSTIN RPH

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	183500000X	Pharmacist	PS52700	FL

General Provider Information

NPI Number	:	1407250434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERLINE AUGUSTIN RPH

Provider Business Mailing Address
First Line	:	13440 NW 11TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-6612
Country	:	US
Telephone Number	:	786-558-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	13440 NW 11TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33168-6612
Country	:	US
Telephone Number	:	786-558-6188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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