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NPI Code Detail

MEDICARE: FIVE STAR PHARMACY AND DISCOUNT INC

MEDICARE: FIVE STAR PHARMACY AND DISCOUNT 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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPH25730FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15707940OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1780968560
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR PHARMACY AND DISCOUNT INC
Provider Business Mailing Address
First Line : 8428 SW 40TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33155-3226
Country : US
Telephone Number : 305-456-5090
Fax Number : 305-456-5697
Provider Business Practice Location Address
First Line : 8428 BIRD RD
Second Line :
City : MIAMI
State : FL
Zip : 33155-3226
Country : US
Telephone Number : 305-456-5090
Fax Number : 305-456-5697
Authorized Official
Title or Position : PRESIDENT
Name : YANET CARBALLEIRO
Credential :
Telephone Number : 305-359-1187
Provider Enumeration Date : 09/28/2011
Last Update Date : 04/06/2012

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Directions to “FIVE STAR PHARMACY AND DISCOUNT INC ” Practice Location

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