Provider Demographics
NPI:1740638527
Name:OUR PHARMACY NETWORK LLC
Entity type:Organization
Organization Name:OUR PHARMACY NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:DAMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-238-9313
Mailing Address - Street 1:3350 NW 53RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6354
Mailing Address - Country:US
Mailing Address - Phone:844-238-9313
Mailing Address - Fax:844-253-6404
Practice Address - Street 1:3350 NW 53RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6354
Practice Address - Country:US
Practice Address - Phone:844-238-9313
Practice Address - Fax:844-253-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH301673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy