MEDICARE: MASSIVE MARKETING GROUP II 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	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1811386055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSIVE MARKETING GROUP II LLC

Provider Business Mailing Address
First Line	:	7351 WILES RD
Second Line	:	SUITE #103
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4106
Country	:	US
Telephone Number	:	954-806-9309
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 WILES RD
Second Line	:	SUITE #103
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4106
Country	:	US
Telephone Number	:	954-806-9309
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JESTILL TAPIA
Credential	:
Telephone Number	:	954-806-9309

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	03/11/2015

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