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General NPI Number Information
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NPI Number | 1639479512
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Entity Type | Organization
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Legal Business Name | RX DEPOT CORP
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 5559 N STATE ROAD 7
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City | FORT LAUDERDALE
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State | FL
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Zip | 33319-2923
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Country | US
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Telephone | 954-306-6306
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Fax | 954-306-6185
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Provider Business Mailing Address
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Address Line | 5559 N STATE ROAD 7
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City | FORT LAUDERDALE
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State | FL
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Zip | 33319-2923
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Country | US
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Telephone | 954-306-6306
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Fax | 954-306-6185
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAURA SUHANOV
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Credential |
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Telephone | 954-306-6306
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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 | PH 24964
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License Number State | FL
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