Provider Demographics
NPI:1790245207
Name:WHITE ORCHID PHARMACY INC
Entity Type:Organization
Organization Name:WHITE ORCHID PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-404-7542
Mailing Address - Street 1:2328B HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6703
Mailing Address - Country:US
Mailing Address - Phone:954-404-7533
Mailing Address - Fax:954-404-7536
Practice Address - Street 1:2328B HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6703
Practice Address - Country:US
Practice Address - Phone:954-404-7533
Practice Address - Fax:954-404-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019746000Medicaid
2120052OtherPK