MEDICARE: ALLGEN 3 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	PH24724	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5700895	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1386955821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLGEN 3 LLC

Provider Business Mailing Address
First Line	:	1240 PROVIDENCE BLVD STE 7
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7352
Country	:	US
Telephone Number	:	386-259-5124
Fax Number	:	386-259-5128

Provider Business Practice Location Address
First Line	:	1240 PROVIDENCE BLVD STE 7
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-7352
Country	:	US
Telephone Number	:	386-259-5124
Fax Number	:	386-259-5128

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	VIPULKUMAR PATEL
Credential	:
Telephone Number	:	863-409-1075

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	01/14/2011

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Directions to “ALLGEN 3 LLC ” Practice Location

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