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NPI Code Detail

MEDICARE: PALM AVENUE PHAR,MACY, INC.

MEDICARE: PALM AVENUE PHAR,MACY, 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
1332B00000XDurable Medical Equipment & Medical SuppliesPH15576FL
23336C0003XCommunity/Retail PharmacyPH 15576FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PH15576OTHERFLBOARD OF PHARMACY PERMIT

General Provider Information

NPI Number : 1861470999
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALM AVENUE PHAR,MACY, INC.
Provider Business Mailing Address
First Line : 400 PALM AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33010-4718
Country : US
Telephone Number : 305-863-9060
Fax Number : 305-863-4142
Provider Business Practice Location Address
First Line : 400 PALM AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33010-4718
Country : US
Telephone Number : 305-863-9060
Fax Number : 305-863-4142
Authorized Official
Title or Position : PRESIDENT
Name : MS. VICKY ECHEVARRIA
Credential :
Telephone Number : 305-863-9060
Provider Enumeration Date : 01/09/2006
Last Update Date : 09/11/2025

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