NPI Code Detail JSON Logo

1356508980 NPI number — PHYTOGENICS LLC

NPI Number: 1356508980
Health Care Provider/Practitioner: PHYTOGENICS LLC

Information about “1356508980” NPI (PHYTOGENICS LLC) exists in 1356508980 in HTML format HTML  |  1356508980 in plain Text format TXT  |  1356508980 in PDF (Portable Document Format) PDF  |  1356508980 in an XML format XML  formats.

NPI Number : 1356508980 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356508980",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PHYTOGENICS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4501 NW 31ST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKLAND PARK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33309-3403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-612-5831",
    "MailingAddressFaxNumber": "800-532-0764",
    "FirstLinePracticeLocationAddress": "4501 NW 31ST AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAKLAND PARK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33309-3403",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-612-5831",
    "PracticeLocationAddressFaxNumber": "800-532-0764",
    "EnumerationDate": "05/21/2008",
    "LastUpdateDate": "01/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MOLIERE",
    "AuthorizedOfficialFirstName": "JOELLE",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "CEO/PIC",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RPH MPH",
    "AuthorizedOfficialTelephoneNumber": "954-612-5831",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "335G00000X",
          "TaxonomyName": "Medical Foods Supplier",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336M0003X",
          "TaxonomyName": "Managed Care Organization Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PH23251",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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