MEDICARE: PHYTOGENIX RX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1003491689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYTOGENIX RX

Provider Business Mailing Address
First Line	:	4501 NW 31ST AVE STE 4
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	754-223-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 NW 31ST AVE STE 4
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	754-223-7701
Fax Number	:

Authorized Official
Title or Position	:	PIC
Name	:	GISELE PEAN
Credential	:	PHARMD
Telephone Number	:	866-749-8679

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/16/2021

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Directions to “PHYTOGENIX RX ” Practice Location

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