Provider Demographics
NPI:1306849484
Name:NETGROUP HOME PHARMACY, INC.
Entity Type:Organization
Organization Name:NETGROUP HOME PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-743-9974
Mailing Address - Street 1:521 OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2344
Mailing Address - Country:US
Mailing Address - Phone:561-743-9974
Mailing Address - Fax:561-741-5220
Practice Address - Street 1:521 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2344
Practice Address - Country:US
Practice Address - Phone:561-743-9974
Practice Address - Fax:561-741-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH17919332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4430170001Medicare ID - Type Unspecified