Healthcare Provider Details

I. General information

NPI: 1639474489
Provider Name (Legal Business Name): PHYSICIAN CHOICE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4529 N PINE ISLAND RD
SUNRISE FL
33351-5376
US

IV. Provider business mailing address

4529 N PINE ISLAND RD
SUNRISE FL
33351-5376
US

V. Phone/Fax

Practice location:
  • Phone: 888-389-2014
  • Fax: 888-200-3285
Mailing address:
  • Phone: 888-389-2014
  • Fax: 888-200-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH25249
License Number StateFL

VIII. Authorized Official

Name: SADDAD HADDAD
Title or Position: MANAGER, AO
Credential:
Phone: 888-389-2014