MEDICARE: QMP PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1215206263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QMP PHARMACY LLC

Provider Business Mailing Address
First Line	:	5180 W ATLANTIC AVE
Second Line	:	SUITE 105
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8103
Country	:	US
Telephone Number	:	800-767-0874
Fax Number	:	888-716-6567

Provider Business Practice Location Address
First Line	:	102 W MAIN ST
Second Line	:	SUITE B
City	:	WARSAW
State	:	KY
Zip	:	41095-9300
Country	:	US
Telephone Number	:	800-767-0874
Fax Number	:	888-716-6567

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	JORDAN C SOBLICK
Credential	:
Telephone Number	:	800-767-0874

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	05/25/2012

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