Provider Demographics
NPI:1043365083
Name:HERBMOR COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:HERBMOR COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OYEBODE
Authorized Official - Middle Name:OLADIPO
Authorized Official - Last Name:OYETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-447-1823
Mailing Address - Street 1:9111 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1638
Mailing Address - Country:US
Mailing Address - Phone:954-447-1823
Mailing Address - Fax:954-447-1826
Practice Address - Street 1:9111 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1638
Practice Address - Country:US
Practice Address - Phone:954-447-1823
Practice Address - Fax:954-447-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0016857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH0016857OtherPHARMACY LICENSE #
FLPH0016857OtherPHARMACY LICENSE #
FLBH6502719OtherDEA REGISTRATION #