Provider Demographics
NPI:1598945404
Name:SIMFA ROSE PHARMACEUTICAL SPECIALTY INC
Entity Type:Organization
Organization Name:SIMFA ROSE PHARMACEUTICAL SPECIALTY INC
Other - Org Name:SIMFAROSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:954-435-7200
Mailing Address - Street 1:10016 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6137
Mailing Address - Country:US
Mailing Address - Phone:954-435-7200
Mailing Address - Fax:954-438-1030
Practice Address - Street 1:10016 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6137
Practice Address - Country:US
Practice Address - Phone:954-435-7200
Practice Address - Fax:954-438-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
FLPH230143336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010230OtherPK
FL03239000Medicaid
FL03239000Medicaid