MEDICARE: PHARMACY DEPOT, 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	333600000X	Pharmacy	PH24969	FL

General Provider Information

NPI Number	:	1871895847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY DEPOT, LLC

Provider Business Mailing Address
First Line	:	1304A E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6745
Country	:	US
Telephone Number	:	954-650-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304A E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6745
Country	:	US
Telephone Number	:	954-650-0823
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CHRISTIAN LEO SMITH
Credential	:
Telephone Number	:	954-650-0823

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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Directions to “PHARMACY DEPOT, LLC ” Practice Location

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