MEDICARE: WHITE TIP 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

General Provider Information

NPI Number	:	1790303394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE TIP PHARMACY LLC

Provider Business Mailing Address
First Line	:	411 S FEDERAL HWY STE D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 S FEDERAL HWY STE D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4170
Country	:	US
Telephone Number	:	954-531-0211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IVAN ASHLEY FERGUSON
Credential	:
Telephone Number	:	954-531-0211

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	01/21/2022

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