Healthcare Provider Details

I. General information

NPI: 1265934723
Provider Name (Legal Business Name): PINES DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 NW 100TH PL
PEMBROKE PINES FL
33024-6163
US

IV. Provider business mailing address

631 NW 100TH PL
PEMBROKE PINES FL
33024-6163
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-4900
  • Fax: 954-437-4504
Mailing address:
  • Phone: 954-437-4900
  • Fax: 954-437-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH24151
License Number StateFL

VIII. Authorized Official

Name: ADEKUNLE ADIMULA
Title or Position: PRESIDENT
Credential:
Phone: 954-437-4900