MEDICARE: UNITED PHARMACY 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
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH23965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1043936	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1760624571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHARMACY LLC

Provider Business Mailing Address
First Line	:	3951 HAVERHILL RD N
Second Line	:	SUITE 120-121
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8154
Country	:	US
Telephone Number	:	561-616-9000
Fax Number	:	561-616-9087

Provider Business Practice Location Address
First Line	:	3951 HAVERHILL RD N
Second Line	:	SUITE 120-121
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8154
Country	:	US
Telephone Number	:	561-616-9000
Fax Number	:	561-616-9087

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKHAIL VESSELOV
Credential	:
Telephone Number	:	561-616-9000

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	09/27/2019

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Directions to “UNITED PHARMACY LLC ” Practice Location

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