Provider Demographics
NPI:1154147437
Name:ATLANTIS PHARMACY LTC LLC
Entity type:Organization
Organization Name:ATLANTIS PHARMACY LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:561-232-2893
Mailing Address - Street 1:100 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1120
Mailing Address - Country:US
Mailing Address - Phone:561-232-2893
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1120
Practice Address - Country:US
Practice Address - Phone:561-232-2893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIS PHARMACY RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy