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General NPI Number Information
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NPI Number | 1891104543
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Entity Type | Organization
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Legal Business Name | ATLANTIS PHARMACY RX LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 100 JOHN F KENNEDY DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1120
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Country | US
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Telephone | 561-232-2893
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Fax |
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Provider Business Mailing Address
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Address Line | 100 JOHN F KENNEDY DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1120
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Country | US
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Telephone | 561-232-2893
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACY MANAGER
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Name | MR. DAMIEN DANA SIMMONS
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Credential | PHARMD
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Telephone | 561-232-2893
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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 | PH28389
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License Number State | FL
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