Healthcare Provider Details

I. General information

NPI: 1205065190
Provider Name (Legal Business Name): AMERICAN PHARMACEUTICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 NE 26TH ST
WILTON MANORS FL
33305-1322
US

IV. Provider business mailing address

1430 NE 26TH ST
WILTON MANORS FL
33305-1322
US

V. Phone/Fax

Practice location:
  • Phone: 954-533-3900
  • Fax: 954-530-8769
Mailing address:
  • Phone: 954-533-3900
  • Fax: 954-530-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24087
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH24087
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH24087
License Number StateFL

VIII. Authorized Official

Name: DR. HIEN LE
Title or Position: PHARMACY MANAGER
Credential: PHARM.D
Phone: 954-533-3900