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General NPI Number Information
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NPI Number | 1780244335
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Entity Type | Organization
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Legal Business Name | AMARANTH LIFE SCIENCES PHARMACEUTICAL, INC.
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1731 AVENIDA DEL SOL
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City | BOCA RATON
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State | FL
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Zip | 33432-1742
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Country | US
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Telephone | 561-756-8291
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Fax | 347-342-3030
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Provider Business Mailing Address
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Address Line | 1731 AVENIDA DEL SOL
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City | BOCA RATON
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State | FL
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Zip | 33432-1742
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Country | US
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Telephone | 561-756-8291
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Fax | 347-342-3030
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER WOLF
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Credential |
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Telephone | 561-213-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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