MEDICARE: EXTRA CARE CITY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH30389	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2164639	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861942740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTRA CARE CITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	1620 DANIELS RD STE 130
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5604
Country	:	US
Telephone Number	:	407-890-9241
Fax Number	:	407-542-5164

Provider Business Practice Location Address
First Line	:	1620 DANIELS RD STE 130
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5604
Country	:	US
Telephone Number	:	407-890-9241
Fax Number	:	407-542-5164

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	RUSHI BHAKTA
Credential	:
Telephone Number	:	407-890-9241

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	02/05/2026

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