MEDICARE: DNA PHARMACY 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH20850	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004039	OTHER		PK

General Provider Information

NPI Number	:	1912900226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNA PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	2151 S. HIGHWAY ALT. A1A, SUITE 1500
Second Line	:	THREE PALMS CENTER
City	:	JUPITER
State	:	FL
Zip	:	33477
Country	:	US
Telephone Number	:	561-741-1191
Fax Number	:	561-741-1193

Provider Business Practice Location Address
First Line	:	2151 S. HIGHWAY ALT. A1A, SUITE 1500
Second Line	:	THREE PALMS CENTER
City	:	JUPITER
State	:	FL
Zip	:	33477
Country	:	US
Telephone Number	:	561-741-1191
Fax Number	:	561-741-1193

Authorized Official
Title or Position	:	PIC
Name	:	DAVID UPSON
Credential	:	BS PHARM
Telephone Number	:	561-741-1191

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/21/2016

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Directions to “DNA PHARMACY SERVICES INC ” Practice Location

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