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NPI Code Detail

MEDICARE: OCOEE PROFESSIONAL PHARMACY LLC

MEDICARE: OCOEE PROFESSIONAL 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
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy3922TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22093986OTHERPK

General Provider Information

NPI Number : 1548202211
Entity Type Code : Organization
Provider Name (Legal Business Name) : OCOEE PROFESSIONAL PHARMACY LLC
Provider Business Mailing Address
First Line : 2401 N OCOEE ST
Second Line : STE A
City : CLEVELAND
State : TN
Zip : 37311-3853
Country : US
Telephone Number : 423-472-3561
Fax Number : 423-472-5329
Provider Business Practice Location Address
First Line : 2401 N OCOEE ST STE A
Second Line : STE A
City : CLEVELAND
State : TN
Zip : 37311-3853
Country : US
Telephone Number : 423-472-3561
Fax Number : 423-472-5329
Authorized Official
Title or Position : PHARMACIST
Name : JOE MOORE
Credential :
Telephone Number : 423-667-8532
Provider Enumeration Date : 06/10/2006
Last Update Date : 09/04/2015

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Directions to “OCOEE PROFESSIONAL PHARMACY LLC ” Practice Location

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