Provider Demographics
NPI:1619666526
Name:POLOMAR SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:POLOMAR SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-987-2875
Mailing Address - Street 1:32866 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3124
Mailing Address - Country:US
Mailing Address - Phone:727-202-2217
Mailing Address - Fax:727-361-6197
Practice Address - Street 1:32866 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3124
Practice Address - Country:US
Practice Address - Phone:727-202-2217
Practice Address - Fax:727-361-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy