MEDICARE: PHARMAMEDRX 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	4635	IA
2	3336C0003X	Community/Retail Pharmacy	1648-43	WI
3	3336C0003X	Community/Retail Pharmacy	P07139	MD
4	3336C0003X	Community/Retail Pharmacy	0214001819	VA
5	3336M0002X	Mail Order Pharmacy	PHY.007319-NR	LA
6	3336C0003X	Community/Retail Pharmacy	264992	MN
7	3336C0003X	Community/Retail Pharmacy	400-1538	SD
8	3336C0003X	Community/Retail Pharmacy	14722/7.1	MS
9	3336C0003X	Community/Retail Pharmacy	PH29738	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157904	OTHER		PK

General Provider Information

NPI Number	:	1689030470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMAMEDRX LLC

Provider Business Mailing Address
First Line	:	1201 US HIGHWAY 1
Second Line	:	SUITE 1
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3550
Country	:	US
Telephone Number	:	866-855-6468
Fax Number	:	561-619-5169

Provider Business Practice Location Address
First Line	:	1201 US HIGHWAY 1 STE 1
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3546
Country	:	US
Telephone Number	:	866-855-6468
Fax Number	:	561-619-5169

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY OPERATIONS
Name	:	JENNIFER MOONEY THOMPSON
Credential	:
Telephone Number	:	866-855-6468

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	06/23/2016

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Directions to “PHARMAMEDRX LLC ” Practice Location

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