Provider Demographics
NPI:1578590808
Name:HOLLYWOOD DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:HOLLYWOOD DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-629-1246
Mailing Address - Street 1:1180 N. FEDERAL HGWY
Mailing Address - Street 2:UNIT 1104
Mailing Address - City:FT.LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1469
Mailing Address - Country:US
Mailing Address - Phone:954-629-1246
Mailing Address - Fax:
Practice Address - Street 1:1180 N. FEDERAL HGWY
Practice Address - Street 2:UNIT 1104
Practice Address - City:FT.LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1469
Practice Address - Country:US
Practice Address - Phone:954-629-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305S00000X
FL8602332BP3500X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1011624OtherNCPDP NUMBER
FL1011624OtherNCPDP NUMBER