MEDICARE: DAVE 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	332B00000X	Durable Medical Equipment & Medical Supplies	PH24540	FL
2	3336C0003X	Community/Retail Pharmacy	PH24540	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1055107	OTHER		NCPDP
2	PH24540	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1841514346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVE PHARMACY LLC

Provider Business Mailing Address
First Line	:	5902 ABBEY RD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4110
Country	:	US
Telephone Number	:	954-263-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3436
Country	:	US
Telephone Number	:	954-263-1514
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RAKHI DAVE
Credential	:
Telephone Number	:	954-263-1514

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/30/2010

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