Healthcare Provider Details

I. General information

NPI: 1992602122
Provider Name (Legal Business Name): PRIME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2026
Last Update Date: 10/21/2026
Certification Date: 10/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 N FEDERAL HWY STE 165A
BOCA RATON FL
33487-1683
US

IV. Provider business mailing address

390 NE 191ST ST STE 60530
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 870-888-0627
  • Fax: 870-888-0627
Mailing address:
  • Phone: 870-888-0627
  • Fax: 870-888-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC DECESARE
Title or Position: AP
Credential:
Phone: 870-888-0627