Provider Demographics
NPI:1851791339
Name:MEDICA PHARMACY & COMPOUNDING
Entity Type:Organization
Organization Name:MEDICA PHARMACY & COMPOUNDING
Other - Org Name:MEDICA PHARMACY & COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN-AIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-655-4552
Mailing Address - Street 1:21004 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1132
Mailing Address - Country:US
Mailing Address - Phone:305-570-1933
Mailing Address - Fax:
Practice Address - Street 1:21004 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1132
Practice Address - Country:US
Practice Address - Phone:305-570-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH 284603336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147635OtherPK