MEDICARE: SUPREME PHARMACY AND MEDICAL SUPPLIES 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	P04318	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2038096	OTHER		PK

General Provider Information

NPI Number	:	1598712481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME PHARMACY AND MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	5908 BRECKENRIDGE PARKWAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	813-304-2221
Fax Number	:	888-239-8423

Provider Business Practice Location Address
First Line	:	7936 JOHNSON AVE
Second Line	:
City	:	GLENARDEN
State	:	MD
Zip	:	20706-1772
Country	:	US
Telephone Number	:	301-322-8082
Fax Number	:	301-322-8481

Authorized Official
Title or Position	:	OWNER
Name	:	ALPESH PATEL
Credential	:
Telephone Number	:	813-304-2221

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/24/2018

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