MEDICARE: FIRST CLASS PHARMACY, LLC

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	PP482328	PA

General Provider Information

NPI Number	:	1770827420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CLASS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	7316 FRANKFORD AVE
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3827
Country	:	US
Telephone Number	:	215-331-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	7316 FRANKFORD AVE
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3827
Country	:	US
Telephone Number	:	215-331-3361
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. JASON VIZIROV
Credential	:	PHARMD
Telephone Number	:	215-331-3361

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/20/2012

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