MEDICARE: I CARE PHARMACY 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	PH30940	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2174375	OTHER		PK

General Provider Information

NPI Number	:	1366960346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	34064 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2644
Country	:	US
Telephone Number	:	727-303-3672
Fax Number	:	727-255-5699

Provider Business Practice Location Address
First Line	:	34064 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2644
Country	:	US
Telephone Number	:	727-303-3672
Fax Number	:	727-255-5699

Authorized Official
Title or Position	:	COMPLIANCE OFFICER,AO
Name	:	NICHOLL MARLING
Credential	:
Telephone Number	:	727-303-3672

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	07/19/2018

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Directions to “I CARE PHARMACY LLC ” Practice Location

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