Provider Demographics
NPI:1184645152
Name:PBR INVST CORP
Entity Type:Organization
Organization Name:PBR INVST CORP
Other - Org Name:PALM BEACH PHARMACEUTICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-296-9200
Mailing Address - Street 1:8409 N MILITARY TRL
Mailing Address - Street 2:STE 125
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6316
Mailing Address - Country:US
Mailing Address - Phone:561-775-6430
Mailing Address - Fax:561-625-2498
Practice Address - Street 1:8409 N MILITARY TRL
Practice Address - Street 2:STE 125
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6316
Practice Address - Country:US
Practice Address - Phone:561-775-6430
Practice Address - Fax:561-625-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH218113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006466OtherPK