Provider Demographics
NPI:1336463678
Name:FRIENDLY PHARMACY INC
Entity Type:Organization
Organization Name:FRIENDLY PHARMACY INC
Other - Org Name:FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-448-6680
Mailing Address - Street 1:1623 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2509
Mailing Address - Country:US
Mailing Address - Phone:954-903-0078
Mailing Address - Fax:954-903-0087
Practice Address - Street 1:1623 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2509
Practice Address - Country:US
Practice Address - Phone:954-903-0078
Practice Address - Fax:954-903-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH243783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1054030OtherNCPDP PROVIDER IDENTIFICATION NUMBER