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General NPI Number Information
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NPI Number | 1164709663
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Entity Type | Organization
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Legal Business Name | POLYPILL COMPOUND MEDICATIONS LLC
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 4401 SHERIDAN ST STE B
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3513
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Country | US
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Telephone | 855-765-9745
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Fax | 866-355-0176
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Provider Business Mailing Address
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Address Line | 5701 SW 134TH AVE
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-3100
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Country | US
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Telephone | 407-920-1155
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Fax | 407-540-9614
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Authorized Official
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Title or Position | VP BUSINESS DEVELOPMENT
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Name | CHARLES JACKSON
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Credential |
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Telephone | 407-920-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PH25791
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License Number State | FL
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