Healthcare Provider Details

I. General information

NPI: 1922364827
Provider Name (Legal Business Name): PRESCRIPTION HEADQUARTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 W SUNRISE BLVD SUITE 107
PLANTATION FL
33322-5435
US

IV. Provider business mailing address

8320 W SUNRISE BLVD SUITE 107
PLANTATION FL
33322-5435
US

V. Phone/Fax

Practice location:
  • Phone: 754-200-5054
  • Fax: 754-200-8605
Mailing address:
  • Phone: 754-200-5054
  • Fax: 754-200-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26124
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARY BRESIN
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 754-200-5054