1467632224 NPI number — PRIME PHARMACY SERVICES, LLC

Table of content: (NPI 1467632224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467632224 NPI number — PRIME PHARMACY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME PHARMACY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIME PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467632224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1861 BANKS RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-7707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-977-7875
Provider Business Mailing Address Fax Number:
965-977-7871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2427 PORTER LAKE DR STE 109A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34240-8853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-378-2607
Provider Business Practice Location Address Fax Number:
941-378-2699
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ERBLAT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-378-9004

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH23013 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1030129 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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