Provider Demographics
NPI:1558597211
Name:ROYAL PALM COMPOUNDING PHARMACY LLC
Entity Type:Organization
Organization Name:ROYAL PALM COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-784-0700
Mailing Address - Street 1:7040 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 4-842
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3407
Mailing Address - Country:US
Mailing Address - Phone:561-784-0700
Mailing Address - Fax:561-784-0300
Practice Address - Street 1:117 S STATE ROAD 7
Practice Address - Street 2:SUITE 201
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4338
Practice Address - Country:US
Practice Address - Phone:561-784-0700
Practice Address - Fax:561-784-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH240743336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy