MEDICARE: FRIENDLY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH24378	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1054030	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1336463678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDLY PHARMACY INC

Provider Business Mailing Address
First Line	:	1623 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-903-0078
Fax Number	:	954-903-0087

Provider Business Practice Location Address
First Line	:	1623 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-903-0078
Fax Number	:	954-903-0087

Authorized Official
Title or Position	:	OWNER
Name	:	ARTHUR LUBUS
Credential	:
Telephone Number	:	954-448-6680

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	04/29/2010

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Directions to “FRIENDLY PHARMACY INC ” Practice Location

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