Provider Demographics
NPI:1972776037
Name:FAMILY PHYSICIANS RX INC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS RX INC
Other - Org Name:PHARMCORX 1103
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MAXINE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-919-7399
Mailing Address - Street 1:400 ANSIN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3104
Mailing Address - Country:US
Mailing Address - Phone:305-760-2053
Mailing Address - Fax:407-381-3755
Practice Address - Street 1:1160 S SEMORAN BLVD
Practice Address - Street 2:STE D, E, F
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3280
Practice Address - Country:US
Practice Address - Phone:407-381-3085
Practice Address - Fax:407-381-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH232293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102282400Medicaid
2011341OtherPK