MEDICARE: A1A HEALTH & WELLNESS DISPENSARY

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	332900000X	Non-Pharmacy Dispensing Site	ME92135	FL

General Provider Information

NPI Number	:	1114104221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1A HEALTH & WELLNESS DISPENSARY

Provider Business Mailing Address
First Line	:	PO BOX 4688
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33338-4688
Country	:	US
Telephone Number	:	954-376-7313
Fax Number	:	954-697-0153

Provider Business Practice Location Address
First Line	:	3001 BROADWAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5133
Country	:	US
Telephone Number	:	561-655-2225
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. JOHN CHRISTENSEN
Credential	:	M.D.
Telephone Number	:	561-655-2225

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	05/05/2008

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