Healthcare Provider Details

I. General information

NPI: 1265065783
Provider Name (Legal Business Name): PREVENT RX 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3677 CENTRAL AVE STE A
FORT MYERS FL
33901-8226
US

IV. Provider business mailing address

17389 TYLER AVE
PORT CHARLOTTE FL
33948-1302
US

V. Phone/Fax

Practice location:
  • Phone: 239-243-9025
  • Fax: 877-470-9723
Mailing address:
  • Phone: 239-243-9025
  • Fax: 877-470-9723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMBIORIX MORA ESTEVEZ
Title or Position: OWNER
Credential:
Phone: 201-927-9776