MEDICARE: PHARMA GO OF WEST PARK 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	:	1487924585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMA GO OF WEST PARK LLC

Provider Business Mailing Address
First Line	:	1959 S STATE ROAD 7
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-6733
Country	:	US
Telephone Number	:	954-966-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 S STATE ROAD 7
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-6733
Country	:	US
Telephone Number	:	954-966-0200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MUNR KAZMIR
Credential	:
Telephone Number	:	954-966-0200

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/20/2012

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