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NPI Code Detail

MEDICARE: MOON PHARMACY INC

MEDICARE: MOON 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
13336C0003XCommunity/Retail PharmacyFL

General Provider Information

NPI Number : 1457744484
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOON PHARMACY INC
Provider Business Mailing Address
First Line : 8325 W 24TH AVE
Second Line : BAY 11
City : HIALEAH
State : FL
Zip : 33016-1880
Country : US
Telephone Number : 786-558-9648
Fax Number : 786-362-5347
Provider Business Practice Location Address
First Line : 8325 W 24TH AVE
Second Line : BAY 11
City : HIALEAH
State : FL
Zip : 33016-1880
Country : US
Telephone Number : 786-558-9648
Fax Number : 786-362-5347
Authorized Official
Title or Position : PRESIDENT
Name : ROSELIN LOPEZ
Credential :
Telephone Number : 786-558-9648
Provider Enumeration Date : 03/16/2015
Last Update Date : 02/22/2017

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Directions to “MOON PHARMACY INC ” Practice Location

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