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General NPI Number Information
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NPI Number | 1477051217
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Entity Type | Organization
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Legal Business Name | ATLANTIC PH LLC
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1525 S WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32904-3540
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Country | US
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Telephone | 321-821-4998
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Fax | 321-821-4971
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Provider Business Mailing Address
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Address Line | 3278 LAMANGA DR
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City | MELBOURNE
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State | FL
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Zip | 32940-8524
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Country | US
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Telephone | 321-514-4694
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Fax | 321-821-4971
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Authorized Official
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Title or Position | MANAGER
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Name | NIRMIN NASR
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Credential |
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Telephone | 321-514-4694
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH31134
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License Number State | FL
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