=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851602205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESCRIPTIONS BY MAIL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3579 NORTHLAKE BLVD
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33403-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-721-4900
-----------------------------------------------------
Fax | 561-721-4901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3579 NORTHLAKE BLVD
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33403-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-721-4900
-----------------------------------------------------
Fax | 561-721-4901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO / PRESIDENT
-----------------------------------------------------
Name | MARK LANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-721-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH24421
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------