Provider Demographics
NPI:1972743573
Name:CHOICE PHARMACY 002 INC
Entity Type:Organization
Organization Name:CHOICE PHARMACY 002 INC
Other - Org Name:CHOICE PHARMACY 002 INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAMARZIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-685-4707
Mailing Address - Street 1:401 S PARSONS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5292
Mailing Address - Country:US
Mailing Address - Phone:813-685-4707
Mailing Address - Fax:813-685-4722
Practice Address - Street 1:401 S PARSONS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5292
Practice Address - Country:US
Practice Address - Phone:813-685-4707
Practice Address - Fax:813-685-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH239033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FL002703100Medicaid