MEDICARE: THE PHYSICIAN'S RX, 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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1083890081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PHYSICIAN'S RX, INC.

Provider Business Mailing Address
First Line	:	27902 MEADOW DR
Second Line	:	SUITE 130
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2106
Country	:	US
Telephone Number	:	303-674-2511
Fax Number	:	888-719-1726

Provider Business Practice Location Address
First Line	:	4613 N UNIVERSITY DR
Second Line	:	#292
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4602
Country	:	US
Telephone Number	:	888-719-1725
Fax Number	:	888-719-1726

Authorized Official
Title or Position	:	VP
Name	:	MR. VICTOR J RONDER
Credential	:
Telephone Number	:	303-674-2511

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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Directions to “THE PHYSICIAN'S RX, INC. ” Practice Location

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