MEDICARE: MR RX 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	3336C0003X	Community/Retail Pharmacy	PH23590	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1038327	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1659522738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR RX LLC

Provider Business Mailing Address
First Line	:	10549 N FLORIDA AVE
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33612-6707
Country	:	US
Telephone Number	:	813-936-9700
Fax Number	:	813-936-9729

Provider Business Practice Location Address
First Line	:	10549 N FLORIDA AVE
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33612-6707
Country	:	US
Telephone Number	:	813-936-9700
Fax Number	:	813-936-9729

Authorized Official
Title or Position	:	MGR
Name	:	MAHENDRA PATEL
Credential	:
Telephone Number	:	813-936-9700

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	02/28/2011

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Directions to “MR RX LLC ” Practice Location

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