MEDICARE: CCN AMERICA LP

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	PH30622	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2167925	OTHER		PK

General Provider Information

NPI Number	:	1154783561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCN AMERICA LP

Provider Business Mailing Address
First Line	:	300 PENN CENTER BLVD
Second Line	:	SUITE 505
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5511
Country	:	US
Telephone Number	:	412-349-6300
Fax Number	:	412-349-6724

Provider Business Practice Location Address
First Line	:	1500 W CYPRESS CREEK RD
Second Line	:	SUITE 203
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1833
Country	:	US
Telephone Number	:	877-349-6337
Fax Number	:	412-349-6724

Authorized Official
Title or Position	:	PRESIDENT & CFO
Name	:	THOMAS POLLACK
Credential	:
Telephone Number	:	412-349-6300

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	04/18/2017

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Directions to “CCN AMERICA LP ” Practice Location

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