Provider Demographics
NPI:1689030470
Name:PHARMAMEDRX LLC
Entity Type:Organization
Organization Name:PHARMAMEDRX LLC
Other - Org Name:MINT PHARMACY AND SKIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-855-6468
Mailing Address - Street 1:1201 US HIGHWAY 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3550
Mailing Address - Country:US
Mailing Address - Phone:866-855-6468
Mailing Address - Fax:561-619-5169
Practice Address - Street 1:1201 US HIGHWAY 1 STE 1
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3546
Practice Address - Country:US
Practice Address - Phone:866-855-6468
Practice Address - Fax:561-619-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4635333600000X
FLPH297383336C0003X
WI1648-433336C0003X
MDP071393336C0003X
VA02140018193336C0003X
MN2649923336C0003X
SD400-15383336C0003X
MS14722/7.13336C0003X
LAPHY.007319-NR3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157904OtherPK