Healthcare Provider Details

I. General information

NPI: 1285045302
Provider Name (Legal Business Name): PRIMROSE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 WEST ATLANTIC AVENUE SUITE C 5
DELRAY BEACH FL
33445
US

IV. Provider business mailing address

4733 WEST ATLANTIC AVENUE SUITE C 5
DELRAY BEACH FL
33445
US

V. Phone/Fax

Practice location:
  • Phone: 561-529-4935
  • Fax: 561-404-4056
Mailing address:
  • Phone: 561-529-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGOT LELAND
Title or Position: VP PHARMACY OPERATIONS
Credential:
Phone: 561-203-8576