MEDICARE: MED EXPRESS RX

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	PH25533	FL

General Provider Information

NPI Number	:	1760779615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED EXPRESS RX

Provider Business Mailing Address
First Line	:	608 CITRUS WOOD LN
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33594-3721
Country	:	US
Telephone Number	:	813-361-2571
Fax Number	:	813-681-2610

Provider Business Practice Location Address
First Line	:	1717 SHEPHERD RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-2179
Country	:	US
Telephone Number	:	813-361-2571
Fax Number	:	813-681-2610

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. ASHISH J PATEL
Credential	:	RPH
Telephone Number	:	813-361-2571

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	01/03/2013

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