MEDICARE: GREEN APPLE 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	3336C0003X	Community/Retail Pharmacy		FL

General Provider Information

NPI Number	:	1104187822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN APPLE PHARMACY INC

Provider Business Mailing Address
First Line	:	4545 FOREST HILL BLVD
Second Line	:	BAY 3
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9144
Country	:	US
Telephone Number	:	561-649-4242
Fax Number	:	561-649-4241

Provider Business Practice Location Address
First Line	:	4545 FOREST HILL BLVD
Second Line	:	BAY 3
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9144
Country	:	US
Telephone Number	:	561-649-4242
Fax Number	:	561-649-4241

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. OLUCHI IKE
Credential	:	PHARMACIST
Telephone Number	:	561-649-4242

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	03/12/2014

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