MEDICARE: MEDPOINTPHARMACY, INCORPORATED

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
2	3336C0003X	Community/Retail Pharmacy	PH24655	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5700427	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1770804106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPOINTPHARMACY, INCORPORATED

Provider Business Mailing Address
First Line	:	23020 SANDALFOOT PLAZA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6654
Country	:	US
Telephone Number	:	561-451-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	23020 SANDALFOOT PLAZA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6654
Country	:	US
Telephone Number	:	561-451-2111
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DMITRY BUKRITSKY
Credential	:
Telephone Number	:	954-937-9930

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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Directions to “MEDPOINTPHARMACY, INCORPORATED ” Practice Location

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