=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770990715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2014
-----------------------------------------------------
Last Update Date | 03/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3850 COCONUT CREEK PKWY
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33066-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-532-6633
-----------------------------------------------------
Fax | 954-641-1505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3850 COCONUT CREEK PKWY
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33066-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-532-6633
-----------------------------------------------------
Fax | 954-641-1505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHARMACIST
-----------------------------------------------------
Name | CASEY HYRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-641-1448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH28202
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------