MEDICARE: FITTE ENTERPRISES, INC.

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH25093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5704071	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1215234075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITTE ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	29291 TRIBUNE BLVD
Second Line	:	UNIT 2-3
City	:	PUNTA GORDA
State	:	FL
Zip	:	33955-2216
Country	:	US
Telephone Number	:	941-575-2407
Fax Number	:	941-575-4820

Provider Business Practice Location Address
First Line	:	29291 TRIBUNE BLVD
Second Line	:	UNIT 2-3
City	:	PUNTA GORDA
State	:	FL
Zip	:	33955-2216
Country	:	US
Telephone Number	:	941-575-2407
Fax Number	:	941-575-4820

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN MARK FITTE
Credential	:
Telephone Number	:	757-343-9649

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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Directions to “FITTE ENTERPRISES, INC. ” Practice Location

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