Provider Demographics
NPI:1891104543
Name:ATLANTIS PHARMACY RX LLC
Entity Type:Organization
Organization Name:ATLANTIS PHARMACY RX LLC
Other - Org Name:ATLANTIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:561-232-2893
Mailing Address - Street 1:100 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1120
Mailing Address - Country:US
Mailing Address - Phone:561-232-2893
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1120
Practice Address - Country:US
Practice Address - Phone:561-232-2893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH283893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy