Provider Demographics
NPI:1194124693
Name:PROFESSIONAL PHARMACY & COMPOUNDING SERVICES LLC
Entity type:Organization
Organization Name:PROFESSIONAL PHARMACY & COMPOUNDING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AZUBUEZE
Authorized Official - Middle Name:C
Authorized Official - Last Name:IKEJIANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:9542-743-0074
Mailing Address - Street 1:3921 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5504
Mailing Address - Country:US
Mailing Address - Phone:786-350-2700
Mailing Address - Fax:305-503-6848
Practice Address - Street 1:3921 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5504
Practice Address - Country:US
Practice Address - Phone:786-350-2700
Practice Address - Fax:305-503-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH28410261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health