MEDICARE: MILLENNIUM RX 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	5344	OTHER	FL	DOC NUMBER

General Provider Information

NPI Number	:	1447559562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM RX INC

Provider Business Mailing Address
First Line	:	2955 SW 8TH ST
Second Line	:	SUITE 103-104
City	:	MIAMI
State	:	FL
Zip	:	33135-2862
Country	:	US
Telephone Number	:	305-642-0051
Fax Number	:	305-642-0051

Provider Business Practice Location Address
First Line	:	2955 SW 8TH ST
Second Line	:	SUITE 103-104
City	:	MIAMI
State	:	FL
Zip	:	33135-2862
Country	:	US
Telephone Number	:	305-642-0051
Fax Number	:	305-642-0051

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KEILAN FIFE
Credential	:
Telephone Number	:	305-642-0051

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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Directions to “MILLENNIUM RX INC ” Practice Location

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