MEDICARE: PHARMACY AT ABACOA 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
2	3336L0003X	Long Term Care Pharmacy	PH30819	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2175233	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093222622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY AT ABACOA INC

Provider Business Mailing Address
First Line	:	PO BOX 912
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-0912
Country	:	US
Telephone Number	:	855-349-6800
Fax Number	:	561-630-3771

Provider Business Practice Location Address
First Line	:	1155 MAIN ST
Second Line	:	UNIT 109
City	:	JUPITER
State	:	FL
Zip	:	33458-5263
Country	:	US
Telephone Number	:	561-630-3770
Fax Number	:	561-630-3771

Authorized Official
Title or Position	:	CEO
Name	:	DANIEL SPIVAK
Credential	:
Telephone Number	:	561-630-3770

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	12/10/2025

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Directions to “PHARMACY AT ABACOA INC ” Practice Location

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