MEDICARE: SMP PHARMACY SOLUTIONS #3, 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	3336C0003X	Community/Retail Pharmacy	PH31630	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH31630	OTHER	FL	FLORIDA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1184106668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMP PHARMACY SOLUTIONS #3, LLC

Provider Business Mailing Address
First Line	:	6050 S DIXIE HWY STE 201
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5046
Country	:	US
Telephone Number	:	855-208-8358
Fax Number	:	888-971-3822

Provider Business Practice Location Address
First Line	:	6050 S DIXIE HWY STE 201
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5046
Country	:	US
Telephone Number	:	855-208-8358
Fax Number	:	888-971-3822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARMANDO BARDISA
Credential	:	PHARMD
Telephone Number	:	855-208-8358

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	08/31/2018

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