=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346438678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A C NATIONAL PHARMACY , INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 07/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 896B N FEDERAL HWY
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-582-1293
-----------------------------------------------------
Fax | 954-582-1294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 896B N FEDERAL HWY
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-582-1293
-----------------------------------------------------
Fax | 954-582-1294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | ERICH CORDERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-582-1293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH22974
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------