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General NPI Number Information
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NPI Number | 1699023655
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Entity Type | Organization
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Legal Business Name | PRIME PHARMACY SERVICES, LLC
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Dates
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Enumeration Date | 08/24/2012
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 2427 PORTER LAKE DR SUITE 109
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City | SARASOTA
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State | FL
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Zip | 34240-8853
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Country | US
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Telephone | 941-378-2607
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Fax |
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Provider Business Mailing Address
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Address Line | 2427 PORTER LAKE DR SUITE 109
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City | SARASOTA
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State | FL
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Zip | 34240-8853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK ERBLAT
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Credential |
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Telephone | 561-866-8060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH24204
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License Number State | FL
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