Provider Demographics
NPI:1124553441
Name:EXPRESS PHARMACY OF SPRING LLC
Entity Type:Organization
Organization Name:EXPRESS PHARMACY OF SPRING LLC
Other - Org Name:EXPRESS PHARMACY OF SPRING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-805-8581
Mailing Address - Street 1:141 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1623
Mailing Address - Country:US
Mailing Address - Phone:954-805-8581
Mailing Address - Fax:
Practice Address - Street 1:5039 FM 2920 RD STE C
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3114
Practice Address - Country:US
Practice Address - Phone:281-453-7251
Practice Address - Fax:281-453-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX315683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169227OtherPK