Organization
NORTHWEST MEDICAL PHARMACY
Active
Other names
Northwest Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO DIAZ (OFFICER)
(305) 651-7074
Entity
Organization
Contact information
Practice address
671 NW 119TH ST, NORTH MIAMI, FL 33168-2522
(954) 582-3602
(866) 396-9179
Mailing address
671 NW 119TH ST, NORTH MIAMI, FL 33168-2522
(954) 582-3602
(866) 396-9179
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH24054
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053432
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/24/2009
Last updated
02/17/2012
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