Healthcare Provider Details

I. General information

NPI: 1962573972
Provider Name (Legal Business Name): PHARMA EXPRESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SHOTGUN RD
SUNRISE FL
33326-1940
US

IV. Provider business mailing address

777 SHOTGUN RD
SUNRISE FL
33326-1940
US

V. Phone/Fax

Practice location:
  • Phone: 954-210-7774
  • Fax: 800-219-7213
Mailing address:
  • Phone: 954-210-7774
  • Fax: 800-219-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH15613
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0002898
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28933
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RO00088300
License Number StateNJ

VIII. Authorized Official

Name: SAM KOLTA
Title or Position: TECHNICIAN
Credential:
Phone: 800-219-7212