Provider Demographics
NPI:1912900226
Name:DNA PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:DNA PHARMACY SERVICES INC
Other - Org Name:PALM BEACH COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:UPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:561-741-1191
Mailing Address - Street 1:2151 S. HIGHWAY ALT. A1A, SUITE 1500
Mailing Address - Street 2:THREE PALMS CENTER
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477
Mailing Address - Country:US
Mailing Address - Phone:561-741-1191
Mailing Address - Fax:561-741-1193
Practice Address - Street 1:2151 S. HIGHWAY ALT. A1A, SUITE 1500
Practice Address - Street 2:THREE PALMS CENTER
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477
Practice Address - Country:US
Practice Address - Phone:561-741-1191
Practice Address - Fax:561-741-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336M0002X
FLPH208503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004039OtherPK