MEDICARE: SENIOR CARE PHARMACY OF FLORIDA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	PH18723	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2014992	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023090362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CARE PHARMACY OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	931 FAIRFAX PARK
Second Line	:	ATTN: LYNN CONNOR
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2805
Country	:	US
Telephone Number	:	205-310-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S PIPKIN RD STE 208
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1699
Country	:	US
Telephone Number	:	863-577-1440
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALAN OBRINGER
Credential	:
Telephone Number	:	863-577-1440

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/14/2017

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