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General NPI Number Information
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NPI Number | 1053616771
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Entity Type | Organization
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Legal Business Name | MY PHARMACY RX FL LLC
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 616 21ST ST
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City | VERO BEACH
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State | FL
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Zip | 32960-0951
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Country | US
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Telephone | 772-562-0000
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Fax | 772-562-0077
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Provider Business Mailing Address
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Address Line | 616 21ST ST
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City | VERO BEACH
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State | FL
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Zip | 32960-0951
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Country | US
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Telephone | 772-562-0000
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Fax | 772-562-0077
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | TRAVIS GRIFFITH
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Credential |
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Telephone | 954-691-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25180
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License Number State | FL
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