Provider Demographics
NPI:1093032823
Name:SAMPLE SQUARE PHARMACY
Entity type:Organization
Organization Name:SAMPLE SQUARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-573-5083
Mailing Address - Street 1:428 E SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4424
Mailing Address - Country:US
Mailing Address - Phone:954-573-5083
Mailing Address - Fax:954-783-5083
Practice Address - Street 1:428 E SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4424
Practice Address - Country:US
Practice Address - Phone:954-573-5083
Practice Address - Fax:954-783-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy