MEDICARE: COMPLETE PHARMACY AND MEDICAL SOLUTIONS 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	3336H0001X	Home Infusion Therapy Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336M0003X	Managed Care Organization Pharmacy
5	333600000X	Pharmacy
6	3336C0003X	Community/Retail Pharmacy	PH28339	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2011676	OTHER		PK

General Provider Information

NPI Number	:	1972784841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE PHARMACY AND MEDICAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	117 W MULBERRY ST
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-1328
Country	:	US
Telephone Number	:	217-697-5533
Fax Number	:	800-830-1813

Provider Business Practice Location Address
First Line	:	5829 NW 158TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6721
Country	:	US
Telephone Number	:	305-397-2035
Fax Number	:	866-454-5866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEBBIE DRENNAN
Credential	:
Telephone Number	:	217-697-5533

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	04/03/2015

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