MEDICARE: POLARIS PHARMACY SERVICES OF TAMPA, LLC

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	3336L0003X	Long Term Care Pharmacy	PH30415	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1048152	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154554111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLARIS PHARMACY SERVICES OF TAMPA, LLC

Provider Business Mailing Address
First Line	:	2900 NW 60TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1774
Country	:	US
Telephone Number	:	954-919-1818
Fax Number	:	954-923-9261

Provider Business Practice Location Address
First Line	:	5908 HAMPTON OAKS PKWY STE N
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9505
Country	:	US
Telephone Number	:	877-891-0005
Fax Number	:	877-891-0006

Authorized Official
Title or Position	:	CORPORATE DIRECTOR OF COMPLIANCE, C
Name	:	REGINA HUNT
Credential	:
Telephone Number	:	800-589-9747

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	02/19/2026

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