Healthcare Provider Details

I. General information

NPI: 1457393993
Provider Name (Legal Business Name): FCS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BROKEN SOUND PKWY SUITE 252
BOCA RATON FL
33487-3507
US

IV. Provider business mailing address

PO BOX 533211
CHARLOTTE NC
28290-3211
US

V. Phone/Fax

Practice location:
  • Phone: 800-223-7151
  • Fax: 561-995-9162
Mailing address:
  • Phone: 800-223-7151
  • Fax: 561-995-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH18941
License Number StateFL

VIII. Authorized Official

Name: MR. JARRETT BOSTWICK
Title or Position: PRESIDENT
Credential:
Phone: 561-314-1700