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NPI Code Detail

MEDICARE: ATLANTIS PHARMACY RX LLC

MEDICARE: ATLANTIS PHARMACY RX 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
13336C0003XCommunity/Retail PharmacyPH28389FL

Other Identifiers

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

General Provider Information

NPI Number : 1891104543
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTIS PHARMACY RX 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/PHARMACY MANAGER
Name : MR. DAMIEN DANA SIMMONS
Credential : PHARMD
Telephone Number : 561-232-2893
Provider Enumeration Date : 08/07/2014
Last Update Date : 08/07/2014

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Directions to “ATLANTIS PHARMACY RX LLC ” Practice Location

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