Provider Demographics
NPI:1376957985
Name:ABSOLUTE PHARMACY, LLC
Entity Type:Organization
Organization Name:ABSOLUTE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:DIEFER
Authorized Official - Last Name:DETTLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:768-239-7676
Mailing Address - Street 1:16011 N. NEBRASKA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549
Mailing Address - Country:US
Mailing Address - Phone:813-999-2700
Mailing Address - Fax:813-999-2701
Practice Address - Street 1:16011 N. NEBRASKA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549
Practice Address - Country:US
Practice Address - Phone:813-999-2700
Practice Address - Fax:813-999-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPH28122333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy