Healthcare Provider Details

I. General information

NPI: 1184645152
Provider Name (Legal Business Name): PBR INVST CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 N MILITARY TRL STE 125
WEST PALM BEACH FL
33410-6316
US

IV. Provider business mailing address

8409 N MILITARY TRL STE 125
WEST PALM BEACH FL
33410-6316
US

V. Phone/Fax

Practice location:
  • Phone: 561-775-6430
  • Fax: 561-625-2498
Mailing address:
  • Phone: 561-775-6430
  • Fax: 561-625-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21811
License Number StateFL

VIII. Authorized Official

Name: GLENN STEPHANOS
Title or Position: PRESIDENT
Credential:
Phone: 561-296-9200