MEDICARE: MEDITERRANEA 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	3336C0003X	Community/Retail Pharmacy	PH23428	FL

General Provider Information

NPI Number	:	1538329313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDITERRANEA PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1177 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4941
Country	:	US
Telephone Number	:	305-820-0423
Fax Number	:	305-820-0426

Provider Business Practice Location Address
First Line	:	1177 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4941
Country	:	US
Telephone Number	:	305-820-0423
Fax Number	:	305-820-0426

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YANAI ALVAREZ
Credential	:
Telephone Number	:	305-820-0423

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	10/15/2008

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