Provider Demographics
NPI:1992268361
Name:PRIME THERAPEUTIC CONSULTING & SERVICES, LLC
Entity type:Organization
Organization Name:PRIME THERAPEUTIC CONSULTING & SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:NERESTANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-810-9549
Mailing Address - Street 1:120 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4715
Mailing Address - Country:US
Mailing Address - Phone:813-810-9549
Mailing Address - Fax:
Practice Address - Street 1:120 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4715
Practice Address - Country:US
Practice Address - Phone:813-810-9549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME THERAPEUTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-11
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Multi-Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1518422971Medicaid