Provider Demographics
NPI:1881848497
Name:PHYSICIAN PREFERRED PHARMACY, INC.
Entity Type:Organization
Organization Name:PHYSICIAN PREFERRED PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAILOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-960-7360
Mailing Address - Street 1:2700 NORTH STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5726
Mailing Address - Country:US
Mailing Address - Phone:954-960-7360
Mailing Address - Fax:954-510-3073
Practice Address - Street 1:2700 NORTH STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-960-7360
Practice Address - Fax:954-510-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336H0001X
FLPH237243336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024238000Medicaid
FL6310000001Medicare NSC