MEDICARE: VISTACARE PHARMACY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH26923	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2150546	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245622117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTACARE PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	1441 E FLETCHER AVE STE 113
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3670
Country	:	US
Telephone Number	:	813-444-4410
Fax Number	:	813-422-7946

Provider Business Practice Location Address
First Line	:	1441 E FLETCHER AVE STE 113
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3670
Country	:	US
Telephone Number	:	813-444-4410
Fax Number	:	813-422-7946

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	NAZIR HASSAN
Credential	:
Telephone Number	:	813-444-4410

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	06/08/2022

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Directions to “VISTACARE PHARMACY SERVICES LLC ” Practice Location

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