Healthcare Provider Details

I. General information

NPI: 1902847866
Provider Name (Legal Business Name): PHARMCORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4431
US

IV. Provider business mailing address

1109 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4431
US

V. Phone/Fax

Practice location:
  • Phone: 954-455-3822
  • Fax: 954-455-3835
Mailing address:
  • Phone: 877-540-4748
  • Fax: 801-716-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19163
License Number StateFL

VIII. Authorized Official

Name: GENNADY KRUPNIKAS
Title or Position: PRESIDENT
Credential: B.S.
Phone: 954-455-3822