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General NPI Number Information
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NPI Number | 1679053136
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Entity Type | Organization
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Legal Business Name | POLARFROGRX INC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 9375 EMERALD COAST PKWY W STE 27B
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7222
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Country | US
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Telephone | 850-424-7438
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Fax | 850-396-0587
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Provider Business Mailing Address
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Address Line | 9375 EMERALD COAST PKWY W STE 27B
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7222
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Country | US
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Telephone | 850-424-7438
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Fax | 850-396-0587
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN JOSEPH PETRUCCI
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Credential | RPH.
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Telephone | 850-424-7438
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | TBD
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License Number State | FL
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