MEDICARE: FAMILY PHARMACY AND MEDICAL 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1437595907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY AND MEDICAL LLC

Provider Business Mailing Address
First Line	:	5480 RATTLESNAKE HAMMOCK RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-7454
Country	:	US
Telephone Number	:	239-775-6800
Fax Number	:	239-775-7377

Provider Business Practice Location Address
First Line	:	5480 RATTLESNAKE HAMMOCK RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-7454
Country	:	US
Telephone Number	:	239-775-6800
Fax Number	:	239-775-7377

Authorized Official
Title or Position	:	MGR
Name	:	ADOLFO REQUENA
Credential	:
Telephone Number	:	239-775-6800

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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