MEDICARE: SUPER SAVER PHARMACY 2 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
2	333600000X	Pharmacy	24341	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2122808	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457689812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER SAVER PHARMACY 2 LLC

Provider Business Mailing Address
First Line	:	1800 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-3962
Country	:	US
Telephone Number	:	407-472-6580
Fax Number	:	407-472-6581

Provider Business Practice Location Address
First Line	:	1800 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-3962
Country	:	US
Telephone Number	:	407-472-6580
Fax Number	:	407-472-6581

Authorized Official
Title or Position	:	CEO
Name	:	CRAIG MILLER
Credential	:
Telephone Number	:	516-308-4335

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	02/16/2017

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