Healthcare Provider Details

I. General information

NPI: 1073863312
Provider Name (Legal Business Name): XUBEX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STATE ROAD 436 STE 2064
CASSELBERRY FL
32707-5392
US

IV. Provider business mailing address

500 SR 436 STE 2064
CASSELBERRY FL
32707-5392
US

V. Phone/Fax

Practice location:
  • Phone: 407-378-2309
  • Fax: 866-495-3304
Mailing address:
  • Phone: 407-378-2309
  • Fax: 866-495-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH26324
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD HARIRI
Title or Position: CEO/PRESIDENT
Credential:
Phone: 908-331-2030