Provider Demographics
NPI:1578719290
Name:EXECUTIVE HEALTH, LLC
Entity Type:Organization
Organization Name:EXECUTIVE HEALTH, LLC
Other - Org Name:HARRINGTON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEMYON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAROSOV
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:972-702-9310
Mailing Address - Street 1:19009 PRESTON RD STE 215-106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2496
Mailing Address - Country:US
Mailing Address - Phone:972-702-9310
Mailing Address - Fax:972-458-7111
Practice Address - Street 1:2675 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9342
Practice Address - Country:US
Practice Address - Phone:239-939-3949
Practice Address - Fax:239-939-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13749333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy