MEDICARE: COMMUNITY RX 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	09377	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3406558	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1992807234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RX SOLUTIONS INC

Provider Business Mailing Address
First Line	:	5009 BEATTIES FORD RD
Second Line	:	STE 106
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2859
Country	:	US
Telephone Number	:	704-393-6345
Fax Number	:	704-393-6341

Provider Business Practice Location Address
First Line	:	5009 BEATTIES FORD RD
Second Line	:	STE 106
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2859
Country	:	US
Telephone Number	:	704-393-6345
Fax Number	:	704-393-6341

Authorized Official
Title or Position	:	PHARMACY MGR
Name	:	LEOTIS BLOODWORTH
Credential	:	PHARMD
Telephone Number	:	704-287-1974

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/05/2010

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Directions to “COMMUNITY RX SOLUTIONS INC ” Practice Location

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