MEDICARE: OAKRIDGE 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	302R00000X	Health Maintenance Organization	PS30855	FL

General Provider Information

NPI Number	:	1710397500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKRIDGE PHARMACY

Provider Business Mailing Address
First Line	:	8207 PALAZZO CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-8773
Country	:	US
Telephone Number	:	321-438-3280
Fax Number	:	407-203-6755

Provider Business Practice Location Address
First Line	:	8207 PALAZZO CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-8773
Country	:	US
Telephone Number	:	321-438-3280
Fax Number	:	407-203-6755

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNY THU NGUYEN
Credential	:	PHARMD D
Telephone Number	:	321-438-3280

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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