MEDICARE: PERKINS COMPOUNDING PHARMACY 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	PH17348	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2013454	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326094301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERKINS COMPOUNDING PHARMACY INC

Provider Business Mailing Address
First Line	:	4015 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2403
Country	:	US
Telephone Number	:	772-978-6470
Fax Number	:	772-978-6471

Provider Business Practice Location Address
First Line	:	4015 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2403
Country	:	US
Telephone Number	:	772-978-6470
Fax Number	:	772-978-6471

Authorized Official
Title or Position	:	OWNER PHCST
Name	:	EDWIN PERKINS
Credential	:
Telephone Number	:	772-978-6470

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/09/2013

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