Provider Demographics
NPI:1003491689
Name:PHYTOGENIX RX
Entity Type:Organization
Organization Name:PHYTOGENIX RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:866-749-8679
Mailing Address - Street 1:4501 NW 31ST AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3403
Mailing Address - Country:US
Mailing Address - Phone:754-223-7701
Mailing Address - Fax:
Practice Address - Street 1:4501 NW 31ST AVE STE 4
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-3403
Practice Address - Country:US
Practice Address - Phone:754-223-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYTOGENICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-15
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy