Provider Demographics
NPI:1699847137
Name:PHARMAQUICK LLC
Entity Type:Organization
Organization Name:PHARMAQUICK LLC
Other - Org Name:MIDTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVIGROD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-531-5816
Mailing Address - Street 1:753 ARTHUR GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3413
Mailing Address - Country:US
Mailing Address - Phone:305-531-5816
Mailing Address - Fax:305-673-4651
Practice Address - Street 1:753 ARTHUR GODFREY RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3413
Practice Address - Country:US
Practice Address - Phone:305-531-5816
Practice Address - Fax:305-673-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH178903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022707200Medicaid
2009859OtherPK
2009859OtherPK