Healthcare Provider Details

I. General information

NPI: 1780053769
Provider Name (Legal Business Name): FIVE PILLARS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2015
Last Update Date: 09/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N UNIVERSITY DR SUITE 112
PEMBROKE PINES FL
33024-3617
US

IV. Provider business mailing address

2301 N UNIVERSITY DR SUITE 112
PEMBROKE PINES FL
33024-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-404-6610
  • Fax:
Mailing address:
  • Phone: 954-404-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH29389
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH29389
License Number StateFL

VIII. Authorized Official

Name: MR. ARSHAD ALI MOHAMMED
Title or Position: OWNER
Credential:
Phone: 95440406610