MEDICARE: GOOT NURSING HOME PHARMACY 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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336L0003X	Long Term Care Pharmacy	Y02939	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0315538	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013942051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOT NURSING HOME PHARMACY INC

Provider Business Mailing Address
First Line	:	3802 CORPOREX PARK DR
Second Line	:	STE 150
City	:	TAMPA
State	:	FL
Zip	:	33619-1125
Country	:	US
Telephone Number	:	813-318-6039
Fax Number	:

Provider Business Practice Location Address
First Line	:	8826 N 23RD AVE
Second Line	:	SUITE C-2
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4154
Country	:	US
Telephone Number	:	602-995-1320
Fax Number	:	602-995-0264

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALLISON L. BROWN
Credential	:
Telephone Number	:	502-630-7429

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	02/13/2024

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