Healthcare Provider Details

I. General information

NPI: 1053356113
Provider Name (Legal Business Name): HILLMOOR PLAZA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/13/2009
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: 561-753-6768
  • Fax: 561-753-6763
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH13112
License Number StateFL

VIII. Authorized Official

Name: VICTORIA WEIDEMAN
Title or Position: CEO
Credential: PHARM D
Phone: 772-468-0074