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General NPI Number Information
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NPI Number | 1770580292
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Entity Type | Organization
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Legal Business Name | COMMCARE PHARMACY-WPB LLC
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 1689 FORUM PL
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2303
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Country | US
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Telephone | 561-615-0564
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Fax | 561-615-4508
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Provider Business Mailing Address
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Address Line | 855 SW 78TH AVE STE C100
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City | PLANTATION
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State | FL
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Zip | 33324-3223
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Country | US
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Telephone | 954-568-6212
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Fax | 954-568-2765
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUDY BIANCULLI
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Credential |
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Telephone | 954-332-6170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH19356
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License Number State | FL
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