MEDICARE: PHARMACY SOLUTIONS 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	3336C0003X	Community/Retail Pharmacy	8571042	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5129261	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1942211594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY SOLUTIONS INC

Provider Business Mailing Address
First Line	:	1516 WASHINGTON ST
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-3045
Country	:	US
Telephone Number	:	920-553-1225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 WASHINGTON ST
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-3045
Country	:	US
Telephone Number	:	920-553-1225
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARVIN MOORE
Credential	:	PHARMD
Telephone Number	:	920-794-1225

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	03/07/2012

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Directions to “PHARMACY SOLUTIONS INC ” Practice Location

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