1497878326 NPI number — PHARMACY PRACTICE ASSOCIATES, PA

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 1497878326 NPI number — PHARMACY PRACTICE ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY PRACTICE ASSOCIATES, PA
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:
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:
1497878326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4095 STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE L-208
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-8178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-610-0727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4095 STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE L-208
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33467-8178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-610-0727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERRERA
Authorized Official First Name:
DION
Authorized Official Middle Name:
HAYDEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-610-0727

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PU6074 , 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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