MEDICARE: GREENWALL PHARMACY & DISCOUNT ,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	1835P1200X	Pharmacotherapy Pharmacist	PH24428	FL

General Provider Information

NPI Number	:	1649502709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWALL PHARMACY & DISCOUNT ,INC

Provider Business Mailing Address
First Line	:	3390 SW 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2236
Country	:	US
Telephone Number	:	305-448-4388
Fax Number	:	305-448-4390

Provider Business Practice Location Address
First Line	:	3390 SW 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2236
Country	:	US
Telephone Number	:	305-448-4388
Fax Number	:	305-448-4390

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DIANA OLGA TEIJEIRO
Credential	:
Telephone Number	:	305-448-4388

Provider Enumeration Date	:	01/31/2010
Last Update Date	:	01/31/2010

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