MEDICARE: PHARMEDCO PART B SERVICES 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		AL

General Provider Information

NPI Number	:	1164712410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMEDCO PART B SERVICES LLC

Provider Business Mailing Address
First Line	:	355 INDUSTRIAL PARK BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-5550
Country	:	US
Telephone Number	:	334-244-0200
Fax Number	:	334-279-6688

Provider Business Practice Location Address
First Line	:	355 INDUSTRIAL PARK BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-5550
Country	:	US
Telephone Number	:	334-244-0200
Fax Number	:	334-279-6688

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM J TURENNE
Credential	:
Telephone Number	:	334-265-3900

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/08/2011

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Directions to “PHARMEDCO PART B SERVICES LLC ” Practice Location

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