=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881997146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PLUS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5933 S CONGRESS AVE
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-432-2121
-----------------------------------------------------
Fax | 561-432-2127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5933 S CONGRESS AVE
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-432-2121
-----------------------------------------------------
Fax | 561-432-2127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | KIRILL VESSELOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-432-2121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24946
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------