MEDICARE: PHARMACY MEDICAL SERVICES INC

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	3336C0002X	Clinic Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH21749	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	2005742	OTHER		PK

General Provider Information

NPI Number	:	1811933450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY MEDICAL SERVICES INC

Provider Business Mailing Address
First Line	:	201 NW 70TH AVE
Second Line	:	SUITE D-E
City	:	PLANTATION
State	:	FL
Zip	:	33317-2369
Country	:	US
Telephone Number	:	954-641-1448
Fax Number	:	954-641-1505

Provider Business Practice Location Address
First Line	:	201 NW 70TH AVE
Second Line	:	SUITE D-E
City	:	PLANTATION
State	:	FL
Zip	:	33317-2369
Country	:	US
Telephone Number	:	954-641-1448
Fax Number	:	954-641-1505

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	JORGE BASTO
Credential	:	PHARMD
Telephone Number	:	954-581-7171

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/16/2017

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Directions to “PHARMACY MEDICAL SERVICES INC ” Practice Location

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