Provider Demographics
NPI:1699023655
Name:PRIME PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:PRIME PHARMACY SERVICES, LLC
Other - Org Name:PRIME PHARMACY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-866-8060
Mailing Address - Street 1:2427 PORTER LAKE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2427 PORTER LAKE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8853
Practice Address - Country:US
Practice Address - Phone:941-378-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH242043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032079000Medicaid