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General NPI Number Information
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NPI Number | 1215852900
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Entity Type | Organization
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Legal Business Name | EVERGLADES PHARMACY LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 10202 NW 47TH ST
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City | SUNRISE
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State | FL
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Zip | 33351-7980
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Country | US
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Telephone | 844-799-1988
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Fax | 844-799-1988
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Provider Business Mailing Address
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Address Line | 10202 NW 47TH ST
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City | SUNRISE
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State | FL
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Zip | 33351-7980
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Country | US
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Telephone | 844-799-1988
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Fax | 844-799-1988
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Authorized Official
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Title or Position | PIC
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Name | JOSHUA HEIBLUM
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Credential | PHARMD
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Telephone | 305-586-6302
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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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