MEDICARE: M & M FAMILY PHARMACY CORP

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
2	3336C0003X	Community/Retail Pharmacy	PH30974	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2172181	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700301652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & M FAMILY PHARMACY CORP

Provider Business Mailing Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-409-4533
Fax Number	:	786-409-4533

Provider Business Practice Location Address
First Line	:	1535 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-2833
Country	:	US
Telephone Number	:	786-409-4533
Fax Number	:	786-409-4533

Authorized Official
Title or Position	:	PRES
Name	:	DUNIER MONTES DE OCA
Credential	:
Telephone Number	:	786-409-4855

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	07/19/2018

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