Provider Demographics
NPI:1518265008
Name:MPS RX FLORIDA LLC
Entity Type:Organization
Organization Name:MPS RX FLORIDA LLC
Other - Org Name:MILLENNIUM PHARMACY - MIRAMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP BUSINESS SYSTEMS SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-940-2819
Mailing Address - Street 1:100 E KENSINGER DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3556
Mailing Address - Country:US
Mailing Address - Phone:724-940-2490
Mailing Address - Fax:
Practice Address - Street 1:11824 MIRAMAR PKWY
Practice Address - Street 2:BUILDING 9
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5800
Practice Address - Country:US
Practice Address - Phone:724-940-2490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 248543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5704754OtherNCPDP PROVIDER IDENTIFICATION NUMBER