Provider Demographics
NPI:1356786099
Name:EXPRESS PLUS PHARMACY LLC
Entity type:Organization
Organization Name:EXPRESS PLUS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-589-0790
Mailing Address - Street 1:6692 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1954
Mailing Address - Country:US
Mailing Address - Phone:954-589-0790
Mailing Address - Fax:954-416-6132
Practice Address - Street 1:6692 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1954
Practice Address - Country:US
Practice Address - Phone:954-589-0790
Practice Address - Fax:954-416-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH253733336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy