Provider Demographics
NPI:1659995975
Name:PHARMACY FAMILIA LLC
Entity Type:Organization
Organization Name:PHARMACY FAMILIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-531-0461
Mailing Address - Street 1:450 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1604
Mailing Address - Country:US
Mailing Address - Phone:954-531-0461
Mailing Address - Fax:954-531-0713
Practice Address - Street 1:450 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1604
Practice Address - Country:US
Practice Address - Phone:954-531-0461
Practice Address - Fax:954-531-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32741OtherFLORIDA BOARD OF PHARMACY
FL816578Medicaid