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General NPI Number Information
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NPI Number | 1245241884
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Entity Type | Organization
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Legal Business Name | PRIME THERAPEUTICS PHARMACY LLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 6870 SHADOWRIDGE DR STE 111
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City | ORLANDO
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State | FL
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Zip | 32812-9002
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Country | US
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Telephone | 866-554-2673
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Fax | 866-364-2673
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Provider Business Mailing Address
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Address Line | 6870 SHADOWRIDGE DR SUITE 111
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City | ORLANDO
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State | FL
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Zip | 32812-9002
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Country | US
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Telephone | 866-554-2673
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Fax | 866-364-2673
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Authorized Official
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Title or Position | VP & GM SPECIALTY PHARMACY DIST
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Name | ANDREW GLOVER
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Credential |
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Telephone | 612-777-4940
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH19541
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License Number State | FL
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