Provider Demographics
NPI:1619246378
Name:WEST PALM PHARMACY LLC
Entity Type:Organization
Organization Name:WEST PALM PHARMACY LLC
Other - Org Name:WEST PALM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUFAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-249-2130
Mailing Address - Street 1:5760 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4343
Mailing Address - Country:US
Mailing Address - Phone:561-249-2130
Mailing Address - Fax:561-249-2104
Practice Address - Street 1:5760 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4343
Practice Address - Country:US
Practice Address - Phone:561-249-2130
Practice Address - Fax:561-249-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH258473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708485OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5708485OtherNCPDP PROVIDER IDENTIFICATION NUMBER