Healthcare Provider Details

I. General information

NPI: 1184437303
Provider Name (Legal Business Name): REPLENISHRX CONCIERGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7967 W MCNAB RD
TAMARAC FL
33321-8428
US

IV. Provider business mailing address

5804 NW 123RD AVE
CORAL SPRINGS FL
33076-1936
US

V. Phone/Fax

Practice location:
  • Phone: 623-341-1000
  • Fax:
Mailing address:
  • Phone: 623-341-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: SHENATE TABORA
Title or Position: OWNER
Credential: RN
Phone: 623-341-1000