Provider Demographics
NPI:1740419118
Name:GENERIC DEPOT 3 INC
Entity Type:Organization
Organization Name:GENERIC DEPOT 3 INC
Other - Org Name:PRESCRIPTION DEPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RPH
Authorized Official - Phone:954-773-2450
Mailing Address - Street 1:8225 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1541
Mailing Address - Country:US
Mailing Address - Phone:954-773-2450
Mailing Address - Fax:954-773-2455
Practice Address - Street 1:8225 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1541
Practice Address - Country:US
Practice Address - Phone:954-773-2450
Practice Address - Fax:954-773-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH241623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046920OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1046920OtherNCPDP PROVIDER IDENTIFICATION NUMBER