MEDICARE: NUGENEREX PTX3 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

General Provider Information

NPI Number	:	1659848026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUGENEREX PTX3 LLC

Provider Business Mailing Address
First Line	:	10102 USA TODAY WAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707B W 15TH ST
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-7525
Country	:	US
Telephone Number	:	972-528-9767
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	ANTHONY CRISCI
Credential	:
Telephone Number	:	914-527-1183

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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Directions to “NUGENEREX PTX3 LLC ” Practice Location

Language	Start Address	Practice Location

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