Provider Demographics
NPI:1558905661
Name:PROMOD RX, LLC
Entity Type:Organization
Organization Name:PROMOD RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:006-620-5868
Mailing Address - Street 1:2650 SW 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6606
Mailing Address - Country:US
Mailing Address - Phone:855-305-8500
Mailing Address - Fax:833-220-7665
Practice Address - Street 1:2650 SW 145TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6606
Practice Address - Country:US
Practice Address - Phone:855-305-8500
Practice Address - Fax:833-220-7665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMOD RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy