MEDICARE: SIMFA ROSE PHARMACEUTICAL SPECIALTY INC

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	3336L0003X	Long Term Care Pharmacy
3	3336S0011X	Specialty Pharmacy	PH23014	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2010230	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598945404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMFA ROSE PHARMACEUTICAL SPECIALTY INC

Provider Business Mailing Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:	954-438-1030

Provider Business Practice Location Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:	954-438-1030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUZETTE BONANNO
Credential	:	PHRMD
Telephone Number	:	954-435-7200

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	07/13/2022

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