MEDICARE: PALACE 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	PH26114	FL

General Provider Information

NPI Number	:	1790044022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALACE PHARMACY CORP

Provider Business Mailing Address
First Line	:	923 SW 122ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-2477
Country	:	US
Telephone Number	:	786-953-4291
Fax Number	:

Provider Business Practice Location Address
First Line	:	923 SW 122ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-2477
Country	:	US
Telephone Number	:	786-953-4291
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	INES RODRIGUEZ
Credential	:
Telephone Number	:	786-953-4291

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	01/08/2016

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Directions to “PALACE PHARMACY CORP ” Practice Location

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