Healthcare Provider Details

I. General information

NPI: 1780489609
Provider Name (Legal Business Name): PODARIS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 NW 5TH WAY STE 1410B
FORT LAUDERDALE FL
33309-6131
US

IV. Provider business mailing address

711 PALM BLVD
ISLE OF PALMS SC
29451-2151
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-2693
  • Fax: 954-708-1904
Mailing address:
  • Phone: 843-276-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN NESBITT
Title or Position: OWNER
Credential:
Phone: 843-276-4195