Healthcare Provider Details

I. General information

NPI: 1932686615
Provider Name (Legal Business Name): PREVENTION X, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 ELDRON BLVD SE STE 7
PALM BAY FL
32909-6870
US

IV. Provider business mailing address

1850 ELDRON BLVD SE
PALM BAY FL
32909-6870
US

V. Phone/Fax

Practice location:
  • Phone: 321-308-0303
  • Fax: 321-308-0310
Mailing address:
  • Phone: 321-308-0303
  • Fax: 321-308-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH31554
License Number StateFL

VIII. Authorized Official

Name: PATRICK WHITESIDE
Title or Position: CO
Credential:
Phone: 866-773-7305