Provider Demographics
NPI:1831969609
Name:FORMULATE RX PHARMACY, LLC
Entity type:Organization
Organization Name:FORMULATE RX PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:877-340-0042
Mailing Address - Street 1:1049 WILLA SPRINGS DR STE 1051
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5259
Mailing Address - Country:US
Mailing Address - Phone:877-340-0042
Mailing Address - Fax:
Practice Address - Street 1:1049 WILLA SPRINGS DR STE 1051
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5259
Practice Address - Country:US
Practice Address - Phone:877-340-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy