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General NPI Number Information
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NPI Number | 1558905661
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Entity Type | Organization
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Legal Business Name | PROMOD RX, LLC
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 2650 SW 145TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-6606
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Country | US
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Telephone | 855-305-8500
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Fax | 833-220-7665
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Provider Business Mailing Address
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Address Line | 2650 SW 145TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-6606
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Country | US
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Telephone | 855-305-8500
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Fax | 833-220-7665
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | KIM TON
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Credential | PHARMD
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Telephone | 6-620-5868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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