MEDICARE: JERRY PHARMACY AND MEDICAL SUPPLY 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	3336C0003X	Community/Retail Pharmacy	PH22524	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1032628	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1821213133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY PHARMACY AND MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	3855 SW 137TH AVE
Second Line	:	13
City	:	MIAMI
State	:	FL
Zip	:	33175-8820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 SW 137TH AVE
Second Line	:	13
City	:	MIAMI
State	:	FL
Zip	:	33175-8820
Country	:	US
Telephone Number	:	305-225-5007
Fax Number	:	305-225-5008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIO BRUNET
Credential	:
Telephone Number	:	305-225-5007

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	02/26/2008

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