MEDICARE: PHYTOGENICS 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
1	3336C0004X	Compounding Pharmacy
2	3336C0002X	Clinic Pharmacy
3	335G00000X	Medical Foods Supplier
4	3336M0003X	Managed Care Organization Pharmacy
5	3336S0011X	Specialty Pharmacy
6	333600000X	Pharmacy
7	3336C0003X	Community/Retail Pharmacy	PH23251	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2011517	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356508980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYTOGENICS LLC

Provider Business Mailing Address
First Line	:	4501 NW 31ST AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	954-612-5831
Fax Number	:	800-532-0764

Provider Business Practice Location Address
First Line	:	4501 NW 31ST AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	954-612-5831
Fax Number	:	800-532-0764

Authorized Official
Title or Position	:	CEO/PIC
Name	:	JOELLE M MOLIERE
Credential	:	RPH MPH
Telephone Number	:	954-612-5831

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	01/06/2026

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Directions to “PHYTOGENICS LLC ” Practice Location

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