Provider Demographics
NPI:1619492691
Name:WEST PALM BEACH PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:WEST PALM BEACH PHARMACEUTICALS LLC
Other - Org Name:ACCESS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:XIMENA
Authorized Official - Middle Name:SUSANA
Authorized Official - Last Name:PACHECO-VELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-254-5461
Mailing Address - Street 1:2601 S MILITARY TRL STE 25
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7512
Mailing Address - Country:US
Mailing Address - Phone:561-660-7869
Mailing Address - Fax:561-660-7879
Practice Address - Street 1:2601 S MILITARY TRL STE 25
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7512
Practice Address - Country:US
Practice Address - Phone:561-660-7869
Practice Address - Fax:561-660-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 335E00000X
FLPH308903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022697801Medicaid