MEDICARE: PB GARDENS DRUGS 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH29784	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2155559	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710342753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PB GARDENS DRUGS LLC

Provider Business Mailing Address
First Line	:	10800 N MILITARY TRL
Second Line	:	SUITE 119
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6500
Country	:	US
Telephone Number	:	561-622-2141
Fax Number	:	561-622-7449

Provider Business Practice Location Address
First Line	:	4270C DESIGN CENTER DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4225
Country	:	US
Telephone Number	:	561-622-2141
Fax Number	:	561-622-7449

Authorized Official
Title or Position	:	MANAGER
Name	:	CHRISTOPHER CUTOLO
Credential	:
Telephone Number	:	561-622-2141

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	05/05/2020

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Directions to “PB GARDENS DRUGS LLC ” Practice Location

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