MEDICARE: LILIBET BURGOS

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	183500000X	Pharmacist	PS59969	FL

General Provider Information

NPI Number	:	1588297410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIBET BURGOS

Provider Business Mailing Address
First Line	:	12355 SW 42ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9527 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4035
Country	:	US
Telephone Number	:	305-374-9003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/19/2020

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Directions to “ LILIBET BURGOS ” Practice Location

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