Healthcare Provider Details

I. General information

NPI: 1538529698
Provider Name (Legal Business Name): POLARIS SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 NW PLAZA DR STE 206
RIVERSIDE MO
64150-9574
US

IV. Provider business mailing address

2900 NW 60 STREET
FORT LAUDERDALE FL
33309
US

V. Phone/Fax

Practice location:
  • Phone: 314-549-6300
  • Fax: 816-897-4105
Mailing address:
  • Phone: 800-589-9747
  • Fax: 954-923-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROMBRO
Title or Position: CEO
Credential:
Phone: 800-589-9747