Healthcare Provider Details

I. General information

NPI: 1699113902
Provider Name (Legal Business Name): MED CARE CHOICE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 CONSUMER ST 8
RIVIERA BEACH FL
33404-1740
US

IV. Provider business mailing address

3570 CONSUMER ST 8
RIVIERA BEACH FL
33404-1740
US

V. Phone/Fax

Practice location:
  • Phone: 561-283-1243
  • Fax:
Mailing address:
  • Phone: 561-283-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26972
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH26972
License Number StateFL

VIII. Authorized Official

Name: TREPHENE BROWN
Title or Position: OWNER
Credential:
Phone: 561-283-1243