Provider Demographics
NPI:1104605120
Name:PHARMACIST FORMULATIONS LLC
Entity type:Organization
Organization Name:PHARMACIST FORMULATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-258-7076
Mailing Address - Street 1:6506 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6957
Mailing Address - Country:US
Mailing Address - Phone:850-473-9190
Mailing Address - Fax:
Practice Address - Street 1:6506 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6957
Practice Address - Country:US
Practice Address - Phone:850-473-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty