Healthcare Provider Details

I. General information

NPI: 1801720289
Provider Name (Legal Business Name): SPORTPHARM,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7061 CYPRESS RD STE 104
PLANTATION FL
33317-2243
US

IV. Provider business mailing address

7061 CYPRESS RD STE 104
PLANTATION FL
33317-2243
US

V. Phone/Fax

Practice location:
  • Phone: 954-999-5809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WELCH
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 954-355-9030