MEDICARE: PREVENT RX 2, 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265065783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENT RX 2, LLC

Provider Business Mailing Address
First Line	:	17389 TYLER AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-1302
Country	:	US
Telephone Number	:	239-243-9025
Fax Number	:	877-470-9723

Provider Business Practice Location Address
First Line	:	3677 CENTRAL AVE STE A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-243-9025
Fax Number	:	877-470-9723

Authorized Official
Title or Position	:	OWNER
Name	:	AMBIORIX MORA ESTEVEZ
Credential	:
Telephone Number	:	201-927-9776

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	01/28/2026

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Directions to “PREVENT RX 2, LLC ” Practice Location

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