MEDICARE: C M PALACIO 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1477506954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C M PALACIO INC

Provider Business Mailing Address
First Line	:	3664 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5247
Country	:	US
Telephone Number	:	305-822-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3664 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5247
Country	:	US
Telephone Number	:	305-822-1000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORGE RODRIGUEZ
Credential	:
Telephone Number	:	305-822-1000

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/31/2007

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Directions to “C M PALACIO INC ” Practice Location

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