Provider Demographics
NPI:1508250465
Name:BERMUDA PHARMACY #1, PLLC
Entity type:Organization
Organization Name:BERMUDA PHARMACY #1, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER (PDM/ P.I.C.)
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JASTRZEMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:305-903-8092
Mailing Address - Street 1:393 PALM DR
Mailing Address - Street 2:
Mailing Address - City:ISLAMORADA
Mailing Address - State:FL
Mailing Address - Zip Code:33036-4212
Mailing Address - Country:US
Mailing Address - Phone:305-903-8092
Mailing Address - Fax:305-647-0263
Practice Address - Street 1:393 PALM DR
Practice Address - Street 2:
Practice Address - City:ISLAMORADA
Practice Address - State:FL
Practice Address - Zip Code:33036-4212
Practice Address - Country:US
Practice Address - Phone:305-903-8092
Practice Address - Fax:305-647-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0040188333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy