MEDICARE: HIALEAH DISCOUNT 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1740609197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIALEAH DISCOUNT PHARMACY CORP

Provider Business Mailing Address
First Line	:	12861 SW 42 ST.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3435
Country	:	US
Telephone Number	:	305-885-2660
Fax Number	:	786-953-6052

Provider Business Practice Location Address
First Line	:	12861 SW 42 ST.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3435
Country	:	US
Telephone Number	:	305-885-2660
Fax Number	:	786-953-6052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELENA D GARCIA
Credential	:
Telephone Number	:	305-885-2660

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	08/02/2021

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