Healthcare Provider Details

I. General information

NPI: 1215114194
Provider Name (Legal Business Name): RAMSHORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9312 FOREST HILL BLVD
WELLINGTON FL
33411-6577
US

IV. Provider business mailing address

9312 FOREST HILL BLVD
WELLINGTON FL
33411-6577
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-4400
  • Fax: 561-792-0373
Mailing address:
  • Phone: 561-795-4400
  • Fax: 561-792-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK LLOYD
Title or Position: PRESIDENT
Credential:
Phone: 954-865-8442