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NPI Code Detail

MEDICARE: MALECON PHARMACY INC

MEDICARE: MALECON 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
13336S0011XSpecialty Pharmacy
23336M0003XManaged Care Organization Pharmacy
3333600000XPharmacy
43336C0003XCommunity/Retail PharmacyPH6079FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42004325OTHERPK

General Provider Information

NPI Number : 1811034119
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALECON PHARMACY INC
Provider Business Mailing Address
First Line : 5966 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-6814
Country : US
Telephone Number : 305-558-8551
Fax Number : 305-558-8512
Provider Business Practice Location Address
First Line : 5966 W 16TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-6814
Country : US
Telephone Number : 305-558-8551
Fax Number : 305-558-8512
Authorized Official
Title or Position : PRESIDENT
Name : ANDREY SOLOVYEV
Credential :
Telephone Number : 305-558-8551
Provider Enumeration Date : 01/30/2007
Last Update Date : 04/07/2016

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Directions to “MALECON PHARMACY INC ” Practice Location

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