MEDICARE: OSCEOLA PHARMACY OF VERO BEACH 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	3336L0003X	Long Term Care Pharmacy	PH25827	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5708853	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1326310004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSCEOLA PHARMACY OF VERO BEACH INC

Provider Business Mailing Address
First Line	:	1635 14TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-562-3660
Fax Number	:	772-562-3650

Provider Business Practice Location Address
First Line	:	1635 14TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-0435
Country	:	US
Telephone Number	:	772-562-3660
Fax Number	:	772-562-3650

Authorized Official
Title or Position	:	OWNER
Name	:	AMAR PATEL
Credential	:
Telephone Number	:	772-562-3660

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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