MEDICARE: EPOCH PHARMACY SOLUTIONS II LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	27709	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2132537	OTHER		PK

General Provider Information

NPI Number	:	1154607331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPOCH PHARMACY SOLUTIONS II LLC

Provider Business Mailing Address
First Line	:	PO BOX 3670
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3670
Country	:	US
Telephone Number	:	361-894-6430
Fax Number	:	361-894-6431

Provider Business Practice Location Address
First Line	:	1202 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2507
Country	:	US
Telephone Number	:	361-482-0345
Fax Number	:	361-482-0348

Authorized Official
Title or Position	:	OWNER
Name	:	BRUCE ROGERS
Credential	:
Telephone Number	:	361-894-6430

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	02/16/2016

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