Healthcare Provider Details

I. General information

NPI: 1174808125
Provider Name (Legal Business Name): PATIENTS CHOICE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 105
DAVIE FL
33328-3835
US

IV. Provider business mailing address

4801 S UNIVERSITY DR STE 105
DAVIE FL
33328-3835
US

V. Phone/Fax

Practice location:
  • Phone: 954-622-2222
  • Fax: 954-622-2223
Mailing address:
  • Phone: 954-622-2222
  • Fax: 954-622-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25631
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN BROWNSTEIN
Title or Position: OWNER, PIC
Credential: PHARMD
Phone: 954-661-2488