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NPI Code Detail

MEDICARE: ATLANTIS PHARMACY LTC LLC

MEDICARE: ATLANTIS PHARMACY LTC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1154147437
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTIS PHARMACY LTC LLC
Provider Business Mailing Address
First Line : 100 JOHN F KENNEDY DR
Second Line :
City : ATLANTIS
State : FL
Zip : 33462-1120
Country : US
Telephone Number : 561-232-2893
Fax Number :
Provider Business Practice Location Address
First Line : 100 JOHN F KENNEDY DR
Second Line :
City : ATLANTIS
State : FL
Zip : 33462-1120
Country : US
Telephone Number : 561-232-2893
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DAMIEN SIMMONS
Credential : PHARMD
Telephone Number : 561-232-2893
Provider Enumeration Date : 12/02/2024
Last Update Date : 12/02/2024

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Directions to “ATLANTIS PHARMACY LTC LLC ” Practice Location

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