=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134201924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | US1 PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4356 N FEDERAL HWY
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-302-8478
-----------------------------------------------------
Fax | 954-793-4862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4356 N FEDERAL HWY
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-5208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT PHARMACIST
-----------------------------------------------------
Name | ANTOINE MOURANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-302-8478
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH22298
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------