MEDICARE: PALM RX 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH30172	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2160439	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629413737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	700 1ST STREET SOUTH
Second Line	:	STE 1
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880
Country	:	US
Telephone Number	:	863-292-6111
Fax Number	:	863-292-6112

Provider Business Practice Location Address
First Line	:	700 1ST ST S STE 1
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3605
Country	:	US
Telephone Number	:	863-292-6111
Fax Number	:	863-292-6112

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	11/10/2020

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