MEDICARE: JORGES 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	183500000X	Pharmacist	2757	FL

General Provider Information

NPI Number	:	1457419038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORGES PHARMACY, INC

Provider Business Mailing Address
First Line	:	2720 SW 130TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2020
Country	:	US
Telephone Number	:	305-856-1250
Fax Number	:	305-856-4215

Provider Business Practice Location Address
First Line	:	1701 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-2728
Country	:	US
Telephone Number	:	305-856-1250
Fax Number	:	305-856-4215

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JORGE MONTEAGUDO
Credential	:
Telephone Number	:	305-856-1250

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/06/2008

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