MEDICARE: AETNA SPECIALTY PHARMACY

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1386060580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AETNA SPECIALTY PHARMACY

Provider Business Mailing Address
First Line	:	503 SUNPORT LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 SUNPORT LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7874
Country	:	US
Telephone Number	:	407-513-1880
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	NEREIDA PADILLA
Credential	:	RPH
Telephone Number	:	407-513-8626

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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Directions to “AETNA SPECIALTY PHARMACY ” Practice Location

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