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General NPI Number Information
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NPI Number | 1881996924
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Entity Type | Organization
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Legal Business Name | PATRIOT DISCOUNT PHARMACY
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 10071 PINES BLVD UNIT D
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6181
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Country | US
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Telephone | 561-734-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 10071 PINES BLVD UNIT D
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6181
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Country | US
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Telephone | 561-734-2022
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Fax |
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Authorized Official
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Title or Position | D
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Name | RONNIE HALFACRE
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Credential |
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Telephone | 561-734-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH25041
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License Number State | FL
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