Provider Demographics
NPI:1437154051
Name:PHARMACON, INC.
Entity Type:Organization
Organization Name:PHARMACON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-725-0222
Mailing Address - Street 1:160 SW 12TH AVE
Mailing Address - Street 2:STE 101D
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3114
Mailing Address - Country:US
Mailing Address - Phone:954-725-0222
Mailing Address - Fax:
Practice Address - Street 1:160 SW 12TH AVE
Practice Address - Street 2:STE 101D
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3114
Practice Address - Country:US
Practice Address - Phone:954-725-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033030001Medicare ID - Type Unspecified