MEDICARE: RX DEPOT CORP

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	3336C0003X	Community/Retail Pharmacy	PH 24964	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2511	OTHER	FL	DOCUMENT NUMBER

General Provider Information

NPI Number	:	1639479512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RX DEPOT CORP

Provider Business Mailing Address
First Line	:	5559 N STATE ROAD 7
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33319-2923
Country	:	US
Telephone Number	:	954-306-6306
Fax Number	:	954-306-6185

Provider Business Practice Location Address
First Line	:	5559 N STATE ROAD 7
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33319-2923
Country	:	US
Telephone Number	:	954-306-6306
Fax Number	:	954-306-6185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LAURA SUHANOV
Credential	:
Telephone Number	:	954-306-6306

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/27/2010

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Directions to “RX DEPOT CORP ” Practice Location

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