Provider Demographics
NPI:1336372168
Name:MY COMMUNITY PHARMACY LLC
Entity Type:Organization
Organization Name:MY COMMUNITY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MEROEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIEIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:561-876-4043
Mailing Address - Street 1:2615 STATE ROAD 7
Mailing Address - Street 2:SUITE B530
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-753-6768
Mailing Address - Fax:561-753-6763
Practice Address - Street 1:2615 STATE ROAD 7
Practice Address - Street 2:SUITE B530
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-753-6768
Practice Address - Fax:561-753-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH241143336C0003X
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003711000Medicaid