1053746727 NPI number — SIMFAROSE PHARMACEUTICAL SPECIALTY, 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 1053746727 NPI number — SIMFAROSE PHARMACEUTICAL SPECIALTY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMFAROSE PHARMACEUTICAL SPECIALTY, 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:
Provider Other Organization Name Type Code:
6
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:
1053746727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10016 PINES BOULEVARD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-435-7200
Provider Business Mailing Address Fax Number:
954-438-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10008 PINES BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-435-7200
Provider Business Practice Location Address Fax Number:
954-438-1030
Provider Enumeration Date:
09/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BONANNO
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
954-435-7200

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X , with the licence number:  PH25447 , 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)





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