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NPI Code Detail

MEDICARE: COUNTRY CLUB PHARMACY & DISCOUNT INC

MEDICARE: COUNTRY CLUB PHARMACY & DISCOUNT 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
13336L0003XLong Term Care PharmacyPH26903FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13719OTHERFLNUMB

General Provider Information

NPI Number : 1447691555
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRY CLUB PHARMACY & DISCOUNT INC
Provider Business Mailing Address
First Line : 5911 NW 173RD DR
Second Line : # 6
City : HIALEAH
State : FL
Zip : 33015-5121
Country : US
Telephone Number : 305-828-8600
Fax Number : 305-828-8630
Provider Business Practice Location Address
First Line : 5911 NW 173RD DR
Second Line : # 6
City : HIALEAH
State : FL
Zip : 33015-5121
Country : US
Telephone Number : 305-828-8600
Fax Number : 305-828-8630
Authorized Official
Title or Position : PRESIDENT
Name : DAISY MARTINEZ
Credential :
Telephone Number : 305-828-8600
Provider Enumeration Date : 07/17/2013
Last Update Date : 07/17/2013

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Directions to “COUNTRY CLUB PHARMACY & DISCOUNT INC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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