Provider Demographics
NPI:1467632224
Name:PRIME PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:PRIME PHARMACY SERVICES, LLC
Other - Org Name:PRIME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-378-9004
Mailing Address - Street 1:1861 BANKS RD
Mailing Address - Street 2:STE A
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7707
Mailing Address - Country:US
Mailing Address - Phone:954-977-7875
Mailing Address - Fax:965-977-7871
Practice Address - Street 1:2427 PORTER LAKE DR STE 109A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8853
Practice Address - Country:US
Practice Address - Phone:941-378-2607
Practice Address - Fax:941-378-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH230133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1030129OtherNCPDP PROVIDER IDENTIFICATION NUMBER