MEDICARE: PHARMACORE RX 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
2	3336L0003X	Long Term Care Pharmacy	PH29739	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
2	2157794	OTHER		PK

General Provider Information

NPI Number	:	1790141570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACORE RX LLC

Provider Business Mailing Address
First Line	:	5406 HOOVER BLVD STE 19
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5330
Country	:	US
Telephone Number	:	813-580-8040
Fax Number	:	813-580-8041

Provider Business Practice Location Address
First Line	:	13930 LYNMAR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3123
Country	:	US
Telephone Number	:	813-580-8040
Fax Number	:	813-580-8041

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	DAVID CABRERA
Credential	:
Telephone Number	:	813-580-8040

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	03/29/2023

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Directions to “PHARMACORE RX LLC ” Practice Location

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