Provider Demographics
NPI:1770007486
Name:MILLENIUM CLINIC PHARMACY INC
Entity Type:Organization
Organization Name:MILLENIUM CLINIC PHARMACY INC
Other - Org Name:MILLENIUM DADE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHEREEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ABDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-301-5407
Mailing Address - Street 1:12914 SW 133RD CT STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12914 SW 133RD CT STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6585
Practice Address - Country:US
Practice Address - Phone:786-301-5407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH308473336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH30847OtherSTATE PHARMACY LICENSE