MEDICARE: FARMACIA 22-24 HIALEAH 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	PH0013957	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	:	1669566287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA 22-24 HIALEAH INC.

Provider Business Mailing Address
First Line	:	2961 WEST 12 AV
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-888-2224
Fax Number	:	305-885-9918

Provider Business Practice Location Address
First Line	:	2961 WEST 12 AV
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-888-2224
Fax Number	:	305-885-9918

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	FRANCISCO A ORTEGA
Credential	:	RPH
Telephone Number	:	305-888-2224

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/11/2022

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