MEDICARE: POPS NEIGHBORHOOD PHARMACY, 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	3336C0003X	Community/Retail Pharmacy	25641	FL

General Provider Information

NPI Number	:	1477914109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPS NEIGHBORHOOD PHARMACY, LLC

Provider Business Mailing Address
First Line	:	20 NE 2ND AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-3504
Country	:	US
Telephone Number	:	754-227-7252
Fax Number	:	754-227-7788

Provider Business Practice Location Address
First Line	:	20 NE 2ND AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-3504
Country	:	US
Telephone Number	:	754-227-7252
Fax Number	:	754-227-7788

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. ELAINA LIVA
Credential	:
Telephone Number	:	754-227-7252

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/08/2016

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