MEDICARE: CAMBRIDGE PHARMACY SERVICE 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	PH30232	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2160955	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356793616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIDGE PHARMACY SERVICE LLC

Provider Business Mailing Address
First Line	:	3760 NW 126TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2408
Country	:	US
Telephone Number	:	877-778-4088
Fax Number	:	877-778-5549

Provider Business Practice Location Address
First Line	:	3760 NW 126TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2408
Country	:	US
Telephone Number	:	877-778-4088
Fax Number	:	844-744-2302

Authorized Official
Title or Position	:	COO
Name	:	MICHAEL ROSE
Credential	:
Telephone Number	:	877-778-4088

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	03/01/2017

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