MEDICARE: Q R G 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	PH21512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1015569	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	1015569	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1689616104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Q R G INC

Provider Business Mailing Address
First Line	:	5175 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-0531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5175 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-0531
Country	:	US
Telephone Number	:	863-859-3222
Fax Number	:	863-859-3966

Authorized Official
Title or Position	:	OWNER
Name	:	DUANE MCKOWN
Credential	:	RPH
Telephone Number	:	863-859-3222

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	10/04/2007

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Directions to “Q R G INC ” Practice Location

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