MEDICARE: PRIME PHARMACY SERVICES, 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	3336L0003X	Long Term Care Pharmacy	PH24204	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1699023655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME PHARMACY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2427 PORTER LAKE DR
Second Line	:	SUITE 109
City	:	SARASOTA
State	:	FL
Zip	:	34240-8853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 PORTER LAKE DR
Second Line	:	SUITE 109
City	:	SARASOTA
State	:	FL
Zip	:	34240-8853
Country	:	US
Telephone Number	:	941-378-2607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK ERBLAT
Credential	:
Telephone Number	:	561-866-8060

Provider Enumeration Date	:	08/24/2012
Last Update Date	:	08/24/2012

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Directions to “PRIME PHARMACY SERVICES, LLC ” Practice Location

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