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General NPI Number Information
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NPI Number | 1508250465
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Entity Type | Organization
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Legal Business Name | BERMUDA PHARMACY #1, PLLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 393 PALM DR
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City | ISLAMORADA
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State | FL
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Zip | 33036-4212
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Country | US
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Telephone | 305-903-8092
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Fax | 305-647-0263
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Provider Business Mailing Address
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Address Line | 393 PALM DR
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City | ISLAMORADA
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State | FL
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Zip | 33036-4212
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Country | US
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Telephone | 305-903-8092
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Fax | 305-647-0263
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Authorized Official
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Title or Position | PHARMACY MANAGER (PDM/ P.I.C.)
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Name | DR. NICHOLAS JASTRZEMSKI
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Credential | PHARM.D., R.PH.
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Telephone | 305-903-8092
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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 | PS0040188
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License Number State | FL
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