MEDICARE: JOSE ANTONIO VILLAMIL-RODRIGUEZ

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	3336L0003X	Long Term Care Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH25314	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1095682	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1720024110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE ANTONIO VILLAMIL-RODRIGUEZ

Provider Business Mailing Address
First Line	:	16000 NW 27TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6804
Country	:	US
Telephone Number	:	305-621-2005
Fax Number	:	305-620-0905

Provider Business Practice Location Address
First Line	:	16000 NW 27TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6804
Country	:	US
Telephone Number	:	305-621-2005
Fax Number	:	305-620-0905

Authorized Official
Title or Position	:	CEO
Name	:	JUANA VILLAMIL
Credential	:
Telephone Number	:	305-621-2005

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	05/12/2010

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Directions to “JOSE ANTONIO VILLAMIL-RODRIGUEZ ” Practice Location

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