Healthcare Provider Details

I. General information

NPI: 1720784986
Provider Name (Legal Business Name): POLARIS PHARMACY SERVICES OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 02/02/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375B HENNEMAN DR
NORFOLK VA
23513-2401
US

IV. Provider business mailing address

2900 NW 60TH ST
FORT LAUDERDALE FL
33309-1774
US

V. Phone/Fax

Practice location:
  • Phone: 757-901-4100
  • Fax: 757-731-3750
Mailing address:
  • Phone: 800-589-9747
  • Fax: 954-923-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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