MEDICARE: RX CARE OF LA 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	3336C0003X	Community/Retail Pharmacy	PHY6524	LA

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	2135192	OTHER		PK

General Provider Information

NPI Number	:	1972722825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RX CARE OF LA INC

Provider Business Mailing Address
First Line	:	5908 BRECKENRIDGE PARKWAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	813-304-2221
Fax Number	:	888-239-8423

Provider Business Practice Location Address
First Line	:	202 SOUTH AVE
Second Line	:	STE A
City	:	VIVIAN
State	:	LA
Zip	:	71082-3209
Country	:	US
Telephone Number	:	318-375-3784
Fax Number	:	318-375-5009

Authorized Official
Title or Position	:	LICENSING SPECIALIST
Name	:	JESSICA RIVERA
Credential	:
Telephone Number	:	813-304-2221

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/10/2020

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Directions to “RX CARE OF LA INC ” Practice Location

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