Provider Demographics
NPI:1063650208
Name:PROGRESSIVE PHARMACY INC
Entity type:Organization
Organization Name:PROGRESSIVE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEEM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-964-2700
Mailing Address - Street 1:7177 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2906
Mailing Address - Country:US
Mailing Address - Phone:561-964-2700
Mailing Address - Fax:561-964-2711
Practice Address - Street 1:7177 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2906
Practice Address - Country:US
Practice Address - Phone:561-964-2700
Practice Address - Fax:561-964-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355433336C0003X
IL0540204523336C0003X
PANP0009883336C0003X
GAPHNR001218333600000X
TX314673336C0003X
OHNRP.022827700-023336C0003X
MO20170283863336C0003X
FLPH235753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119794OtherPK
FL000866500Medicaid