1740912864 NPI number — POMP RX PHARMACY LLC

Table of content: (NPI 1740912864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740912864 NPI number — POMP RX PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POMP RX PHARMACY 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:
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:
1740912864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2812 W. MLK JR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-328-3970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E ATLANTIC BLVD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33060-7371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-943-3111
Provider Business Practice Location Address Fax Number:
954-782-6685
Provider Enumeration Date:
06/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
HARDIKKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-362-6086

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117281600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com