MEDICARE: ASC PHARMACY 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	3336C0004X	Compounding Pharmacy	PH22490	FL
2	3336S0011X	Specialty Pharmacy	PH22490	FL
3	3336C0003X	Community/Retail Pharmacy	PH22490	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	:	1770625683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASC PHARMACY INC

Provider Business Mailing Address
First Line	:	3416 W 84TH ST
Second Line	:	108
City	:	HIALEAH
State	:	FL
Zip	:	33018-4933
Country	:	US
Telephone Number	:	305-698-5411
Fax Number	:	305-698-5586

Provider Business Practice Location Address
First Line	:	3416 W 84TH ST
Second Line	:	108
City	:	HIALEAH
State	:	FL
Zip	:	33018-4933
Country	:	US
Telephone Number	:	305-698-5411
Fax Number	:	305-698-5586

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASCANIO SERNA
Credential	:
Telephone Number	:	305-698-5411

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	03/07/2023

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Directions to “ASC PHARMACY INC ” Practice Location

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