MEDICARE: 21 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	333600000X	Pharmacy	PH25327	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5705821	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1578860276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21 PHARMACY INC

Provider Business Mailing Address
First Line	:	6105 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5004
Country	:	US
Telephone Number	:	305-261-2220
Fax Number	:	305-261-2290

Provider Business Practice Location Address
First Line	:	6105 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5004
Country	:	US
Telephone Number	:	305-261-2220
Fax Number	:	305-261-2290

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	ODALYS CORRALES
Credential	:
Telephone Number	:	305-261-2220

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	09/10/2012

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Directions to “21 PHARMACY INC ” Practice Location

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