MEDICARE: AFFORDABLE COMMUNITY PHARMACY L L C

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	3336C0003X	Community/Retail Pharmacy	PH26130	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5710480	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1033470588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE COMMUNITY PHARMACY L L C

Provider Business Mailing Address
First Line	:	3011 LINTON BLVD # 103
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6505
Country	:	US
Telephone Number	:	561-450-7514
Fax Number	:	561-450-7619

Provider Business Practice Location Address
First Line	:	4801 LINTON BLVD STE 4A
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6501
Country	:	US
Telephone Number	:	561-450-7514
Fax Number	:	561-450-7619

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL REEL
Credential	:
Telephone Number	:	561-573-2579

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	09/06/2012

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