Provider Demographics
NPI:1780244335
Name:AMARANTH LIFE SCIENCES PHARMACEUTICAL, INC.
Entity type:Organization
Organization Name:AMARANTH LIFE SCIENCES PHARMACEUTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-213-2873
Mailing Address - Street 1:1731 AVENIDA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1742
Mailing Address - Country:US
Mailing Address - Phone:561-756-8291
Mailing Address - Fax:347-342-3030
Practice Address - Street 1:1731 AVENIDA DEL SOL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1742
Practice Address - Country:US
Practice Address - Phone:561-756-8291
Practice Address - Fax:347-342-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy