Healthcare Provider Details

I. General information

NPI: 1215852900
Provider Name (Legal Business Name): EVERGLADES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10202 NW 47TH ST
SUNRISE FL
33351-7980
US

IV. Provider business mailing address

10202 NW 47TH ST
SUNRISE FL
33351-7980
US

V. Phone/Fax

Practice location:
  • Phone: 844-799-1988
  • Fax: 844-799-1988
Mailing address:
  • Phone: 844-799-1988
  • Fax: 844-799-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSHUA HEIBLUM
Title or Position: PIC
Credential: PHARMD
Phone: 305-586-6302