Healthcare Provider Details

I. General information

NPI: 1588097828
Provider Name (Legal Business Name): IMPERIAL POINT PHARMACY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 09/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 N FEDERAL HWY
FORT LAUDERDALE FL
33308-1906
US

IV. Provider business mailing address

6310 N FEDERAL HWY
FORT LAUDERDALE FL
33308-1906
US

V. Phone/Fax

Practice location:
  • Phone: 954-210-7350
  • Fax: 954-736-4321
Mailing address:
  • Phone: 954-210-7350
  • Fax: 954-736-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26971
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH26971
License Number StateFL

VIII. Authorized Official

Name: MR. LAWRENCE E. MANN
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH.
Phone: 954-210-7350