MEDICARE: COMMUNITY 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1598478414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PHARMACY

Provider Business Mailing Address
First Line	:	4054 SAWYER RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-1272
Country	:	US
Telephone Number	:	941-552-1189
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 N HIMES AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6229
Country	:	US
Telephone Number	:	813-769-0879
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	VINCE PAYNE
Credential	:
Telephone Number	:	941-552-1189

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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Directions to “COMMUNITY PHARMACY ” Practice Location

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