MEDICARE: PROFESSIONAL PHARMACY SERVICES AND DME 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	PH23089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528240736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY SERVICES AND DME INC.

Provider Business Mailing Address
First Line	:	10993 SW 186TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-6812
Country	:	US
Telephone Number	:	305-253-6634
Fax Number	:	305-253-6635

Provider Business Practice Location Address
First Line	:	10993 SW 186TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-6812
Country	:	US
Telephone Number	:	305-253-6634
Fax Number	:	305-253-6635

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. PEDRO PABLO ROGES
Credential	:	PHARM.D.
Telephone Number	:	305-505-7486

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	05/29/2008

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