MEDICARE: DIACARERX INC

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	3336M0002X	Mail Order Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH22207	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1019923	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1053322693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIACARERX INC

Provider Business Mailing Address
First Line	:	11 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 S DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3727
Country	:	US
Telephone Number	:	800-977-7698
Fax Number	:	888-886-4995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT KREBS
Credential	:
Telephone Number	:	800-920-0411

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/15/2008

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Directions to “DIACARERX INC ” Practice Location

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