Healthcare Provider Details

I. General information

NPI: 1730725565
Provider Name (Legal Business Name): PRYME RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N UNIVERSITY DR STE E200
SUNRISE FL
33351-6244
US

IV. Provider business mailing address

3265 TRAFALGER CIR
BOCA RATON FL
33434-5333
US

V. Phone/Fax

Practice location:
  • Phone: 855-779-6379
  • Fax:
Mailing address:
  • Phone: 561-221-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANNA KARINA RUBIO
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-221-8397