Healthcare Provider Details

I. General information

NPI: 1356508980
Provider Name (Legal Business Name): PHYTOGENICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 NW 31ST AVE
OAKLAND PARK FL
33309-3403
US

IV. Provider business mailing address

4501 NW 31ST AVE
OAKLAND PARK FL
33309-3403
US

V. Phone/Fax

Practice location:
  • Phone: 954-612-5831
  • Fax: 800-532-0764
Mailing address:
  • Phone: 954-612-5831
  • Fax: 800-532-0764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23251
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOELLE M MOLIERE
Title or Position: CEO/PIC
Credential: RPH MPH
Phone: 954-612-5831