MEDICARE: SARATOGA PHARMACY 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	27688	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5903871	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1508151960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARATOGA PHARMACY LLC

Provider Business Mailing Address
First Line	:	12650 N BEACH ST
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4243
Country	:	US
Telephone Number	:	817-431-9700
Fax Number	:	817-562-5700

Provider Business Practice Location Address
First Line	:	12650 N BEACH ST STE 112
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4243
Country	:	US
Telephone Number	:	817-431-9700
Fax Number	:	817-562-5700

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	HARESH BHAGAT
Credential	:
Telephone Number	:	817-431-9700

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	11/28/2011

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Directions to “SARATOGA PHARMACY LLC ” Practice Location

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