MEDICARE: CHARLIE RX 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	333600000X	Pharmacy		FL

General Provider Information

NPI Number	:	1740426758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIE RX INC

Provider Business Mailing Address
First Line	:	551 E 49TH ST
Second Line	:	SUITE 16
City	:	HIALEAH
State	:	FL
Zip	:	33013-1904
Country	:	US
Telephone Number	:	305-681-8389
Fax Number	:	305-681-8398

Provider Business Practice Location Address
First Line	:	551 E 49TH ST
Second Line	:	SUITE 16
City	:	HIALEAH
State	:	FL
Zip	:	33013-1904
Country	:	US
Telephone Number	:	305-681-8389
Fax Number	:	305-681-8398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARLOS SERRANO
Credential	:
Telephone Number	:	305-688-3891

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/17/2009

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Directions to “CHARLIE RX INC ” Practice Location

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