Healthcare Provider Details

I. General information

NPI: 1437154051
Provider Name (Legal Business Name): PHARMACON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SW 12TH AVE STE 101D
DEERFIELD BEACH FL
33442-3114
US

IV. Provider business mailing address

160 SW 12TH AVE STE 101D
DEERFIELD BEACH FL
33442-3114
US

V. Phone/Fax

Practice location:
  • Phone: 954-725-0222
  • Fax:
Mailing address:
  • Phone: 954-725-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD D MOSS
Title or Position: DIRECTOR
Credential:
Phone: 954-725-0222