Healthcare Provider Details

I. General information

NPI: 1902156284
Provider Name (Legal Business Name): FILL-A-SCRIPT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 107TH AVE STE 30
MIAMI FL
33165-2492
US

IV. Provider business mailing address

2500 SW 107TH AVE #30
MIAMI FL
33165
US

V. Phone/Fax

Practice location:
  • Phone: 305-226-0181
  • Fax:
Mailing address:
  • Phone: 305-226-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26326
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH26327
License Number StateFL

VIII. Authorized Official

Name: DARLIN ROMAN
Title or Position: SECRETARY
Credential:
Phone: 786-300-9150