MEDICARE: VIP PHARMACY OF LAKE WORTH

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	333600000X	Pharmacy	PH25221	FL

General Provider Information

NPI Number	:	1508162017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP PHARMACY OF LAKE WORTH

Provider Business Mailing Address
First Line	:	3093 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3631
Country	:	US
Telephone Number	:	561-433-9933
Fax Number	:	561-433-9969

Provider Business Practice Location Address
First Line	:	3093 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3631
Country	:	US
Telephone Number	:	561-433-9933
Fax Number	:	561-433-9969

Authorized Official
Title or Position	:	OWNER
Name	:	NEIL KAUFMAN
Credential	:
Telephone Number	:	561-951-6800

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	01/31/2011

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