Provider Demographics
NPI:1609845502
Name:LINTON SQUARE PHARMACY & MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:LINTON SQUARE PHARMACY & MEDICAL SUPPLIES INC
Other - Org Name:LINTON SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BENEFICIAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN-AMOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-272-0015
Mailing Address - Street 1:1601 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6368
Mailing Address - Country:US
Mailing Address - Phone:561-272-0015
Mailing Address - Fax:561-272-3059
Practice Address - Street 1:1601 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6368
Practice Address - Country:US
Practice Address - Phone:561-272-0015
Practice Address - Fax:561-272-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH242293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106586600Medicaid
FL106586601Medicaid
2012143OtherPK
FL106586601Medicaid