Provider Demographics
NPI:1770580292
Name:COMMCARE PHARMACY-WPB LLC
Entity type:Organization
Organization Name:COMMCARE PHARMACY-WPB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-332-6170
Mailing Address - Street 1:855 SW 78TH AVE
Mailing Address - Street 2:STE C100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3223
Mailing Address - Country:US
Mailing Address - Phone:954-568-6212
Mailing Address - Fax:954-568-2765
Practice Address - Street 1:1689 FORUM PL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2303
Practice Address - Country:US
Practice Address - Phone:561-615-0564
Practice Address - Fax:561-615-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH193563336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015699OtherPK
FL026144100Medicaid
2015699OtherPK
FL026144100Medicaid
FL026144102Medicaid