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General NPI Number Information
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NPI Number | 1740638527
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Entity Type | Organization
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Legal Business Name | OUR PHARMACY NETWORK LLC
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 3350 NW 53RD ST SUITE 103
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-6354
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Country | US
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Telephone | 844-238-9313
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Fax | 844-253-6404
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Provider Business Mailing Address
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Address Line | 3350 NW 53RD ST SUITE 103
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-6354
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Country | US
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Telephone | 844-238-9313
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Fax | 844-253-6404
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Authorized Official
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Title or Position | MGR
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Name | DAMAINE JOHNSON
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Credential |
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Telephone | 844-238-9313
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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 | PH30167
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License Number State | FL
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