Organization
COMMCARE PHARMACY MIA LLC
Active
Other names
COMMCARE PHARMACY MIA
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD DOUGHERTY (COO)
(954) 332-6170
Entity
Organization
Contact information
Practice address
1801 CORAL WAY, STE 115, MIAMI, FL 33145-2790
(305) 854-5535
(305) 854-5929
Mailing address
855 SW 78TH AVE, STE C100, PLANTATION, FL 33324-3223
(954) 568-6212
(954) 568-2765
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PH21974
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031649100
—
FL
01
—
2006806
PK
—
Enumeration date
08/10/2006
Last updated
06/20/2016
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