1003871492 NPI number — FAMILY PHYSICIANS RX INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003871492 NPI number — FAMILY PHYSICIANS RX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHYSICIANS RX INC
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:
FIVE STAR RX
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:
1003871492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 ANSIN BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-760-2053
Provider Business Mailing Address Fax Number:
954-321-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N MIAMI BEACH BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33162-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-874-0072
Provider Business Practice Location Address Fax Number:
305-627-3114
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
MAXINE
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
305-919-7399

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH21884 , 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: 102279900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".