MEDICARE: TRI-PALM 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	183500000X	Pharmacist	PH9518	FL

General Provider Information

NPI Number	:	1700882768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-PALM PHARMACY INC.

Provider Business Mailing Address
First Line	:	10484 STRINGFELLOW RD
Second Line	:	STE 2
City	:	ST JAMES CITY
State	:	FL
Zip	:	33956-3208
Country	:	US
Telephone Number	:	239-283-2141
Fax Number	:	239-283-2301

Provider Business Practice Location Address
First Line	:	10484 STRINGFELLOW RD
Second Line	:	STE 2
City	:	ST JAMES CITY
State	:	FL
Zip	:	33956-3208
Country	:	US
Telephone Number	:	239-283-2141
Fax Number	:	239-283-2301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT RONALD PINTA
Credential	:
Telephone Number	:	239-283-2141

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/22/2020

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