Provider Demographics
NPI:1073874525
Name:PLANTATION PHARMACY INC
Entity Type:Organization
Organization Name:PLANTATION PHARMACY INC
Other - Org Name:THE PLANTATION PHARMACY AT MIDTOWN 24
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-829-5465
Mailing Address - Street 1:700 SW 78TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3298
Mailing Address - Country:US
Mailing Address - Phone:954-473-8441
Mailing Address - Fax:954-473-8443
Practice Address - Street 1:700 SW 78TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3313
Practice Address - Country:US
Practice Address - Phone:954-473-8441
Practice Address - Fax:954-473-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH261713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5710644OtherNCPDP PROVIDER IDENTIFICATION NUMBER