Provider Demographics
NPI:1760624571
Name:UNITED PHARMACY LLC
Entity Type:Organization
Organization Name:UNITED PHARMACY LLC
Other - Org Name:UNITED PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-616-9000
Mailing Address - Street 1:3951 HAVERHILL RD N
Mailing Address - Street 2:SUITE 120-121
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8154
Mailing Address - Country:US
Mailing Address - Phone:561-616-9000
Mailing Address - Fax:561-616-9087
Practice Address - Street 1:3951 HAVERHILL RD N
Practice Address - Street 2:SUITE 120-121
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8154
Practice Address - Country:US
Practice Address - Phone:561-616-9000
Practice Address - Fax:561-616-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
FLPH239653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00111500Medicaid
FL00111501Medicaid
1043936OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL00111500Medicaid