MEDICARE: CITY DISCOUNT PHARMACY

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	PH30214	FL

General Provider Information

NPI Number	:	1598115958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DISCOUNT PHARMACY

Provider Business Mailing Address
First Line	:	2330 N WICKHAM RD STE 7
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8183
Country	:	US
Telephone Number	:	321-425-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N WICKHAM RD STE 7
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8183
Country	:	US
Telephone Number	:	321-425-4377
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. NIRMIN NASR
Credential	:
Telephone Number	:	321-514-4694

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	06/17/2016

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