Provider Demographics
NPI:1790088805
Name:YOUR FRIENDLY PHARMACY INC
Entity Type:Organization
Organization Name:YOUR FRIENDLY PHARMACY INC
Other - Org Name:YOUR FRIENDLY PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-420-5273
Mailing Address - Street 1:458 W HILLSBORO BLVD
Mailing Address - Street 2:458 B
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1604
Mailing Address - Country:US
Mailing Address - Phone:954-420-5273
Mailing Address - Fax:954-420-5276
Practice Address - Street 1:458 W HILLSBORO BLVD
Practice Address - Street 2:458 B
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1604
Practice Address - Country:US
Practice Address - Phone:954-420-5273
Practice Address - Fax:954-420-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5703067OtherNCPDP PROVIDER IDENTIFICATION NUMBER