MEDICARE: DAVID'S PHARMACY, 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	333600000X	Pharmacy	PH5077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1006837	OTHER	FL	NABP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073505954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID'S PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2302 W MARTIN LUTHER KING
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6406
Country	:	US
Telephone Number	:	813-870-1967
Fax Number	:	813-870-3277

Provider Business Practice Location Address
First Line	:	2302 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6406
Country	:	US
Telephone Number	:	813-870-1967
Fax Number	:	813-870-3277

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ORESTES DAVID CARTAYA
Credential	:	R. PHARMACIST
Telephone Number	:	813-870-1967

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/18/2013

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