MEDICARE: US1 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	PH22298	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1022590	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1134201924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US1 PHARMACY INC

Provider Business Mailing Address
First Line	:	4356 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4356 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5208
Country	:	US
Telephone Number	:	954-302-8478
Fax Number	:	954-793-4862

Authorized Official
Title or Position	:	PRESIDENT PHARMACIST
Name	:	ANTOINE MOURANI
Credential	:
Telephone Number	:	954-302-8478

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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Directions to “US1 PHARMACY INC ” Practice Location

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