MEDICARE: WEST PALM BEACH PHARMACEUTICALS 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	3336C0003X	Community/Retail Pharmacy	PH30890	FL

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

General Provider Information

NPI Number	:	1619492691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PALM BEACH PHARMACEUTICALS LLC

Provider Business Mailing Address
First Line	:	2601 S MILITARY TRL STE 25
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7512
Country	:	US
Telephone Number	:	561-660-7869
Fax Number	:	561-660-7879

Provider Business Practice Location Address
First Line	:	2601 S MILITARY TRL STE 25
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7512
Country	:	US
Telephone Number	:	561-660-7869
Fax Number	:	561-660-7879

Authorized Official
Title or Position	:	MANAGER
Name	:	XIMENA SUSANA PACHECO-VELIZ
Credential	:
Telephone Number	:	561-254-5461

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	10/15/2020

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