MEDICARE: LIVING WELL 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1417209396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL PHARMACY

Provider Business Mailing Address
First Line	:	1203 E SUNRISE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2810
Country	:	US
Telephone Number	:	954-501-5451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 E SUNRISE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2810
Country	:	US
Telephone Number	:	954-501-5451
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JENNIFER WILLIAMS
Credential	:
Telephone Number	:	954-501-5451

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “LIVING WELL PHARMACY ” Practice Location

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