1629567474 NPI number — PERFECTION RX LLC

Table of content: (NPI 1629567474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629567474 NPI number — PERFECTION RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFECTION RX 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:
PERFECTION 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:
1629567474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3248 LANTANA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-898-1450
Provider Business Mailing Address Fax Number:
561-223-2472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3248 LANTANA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-898-1450
Provider Business Practice Location Address Fax Number:
561-898-1451
Provider Enumeration Date:
05/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLBY
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
561-898-1450

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH31396 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DO NOT HAVE , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2177748 . This is a "PK" identifier . This identifiers is of the category "OTHER".