Provider Demographics
NPI:1639474489
Name:PHYSICIAN CHOICE PHARMACY LLC
Entity Type:Organization
Organization Name:PHYSICIAN CHOICE PHARMACY LLC
Other - Org Name:PHYSICIAN CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, AO
Authorized Official - Prefix:
Authorized Official - First Name:SADDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-389-2014
Mailing Address - Street 1:4529 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5376
Mailing Address - Country:US
Mailing Address - Phone:888-389-2014
Mailing Address - Fax:888-200-3285
Practice Address - Street 1:4529 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5376
Practice Address - Country:US
Practice Address - Phone:888-389-2014
Practice Address - Fax:888-200-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH252493336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007346800Medicaid
2134207OtherPK
FL007346800Medicaid