Healthcare Provider Details

I. General information

NPI: 1295381812
Provider Name (Legal Business Name): IMPERIAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FEDERAL HWY STE 100
HALLANDALE BEACH FL
33009-4373
US

IV. Provider business mailing address

72 HOPE RD
HOLLAND PA
18966-5409
US

V. Phone/Fax

Practice location:
  • Phone: 215-206-4008
  • Fax:
Mailing address:
  • Phone: 215-206-4008
  • 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

VIII. Authorized Official

Name: IRINA MINKOVICH
Title or Position: MANAGER
Credential: RPH
Phone: 215-206-4008