Provider Demographics
NPI:1427758275
Name:ARCHANGEL PHARMACY LLC
Entity type:Organization
Organization Name:ARCHANGEL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-280-9084
Mailing Address - Street 1:7306 STATE ROAD 52 STE 4
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6750
Mailing Address - Country:US
Mailing Address - Phone:646-280-9084
Mailing Address - Fax:
Practice Address - Street 1:7306 STATE ROAD 52 STE 4
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6750
Practice Address - Country:US
Practice Address - Phone:646-280-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy