Provider Demographics
NPI:1902195415
Name:POLARIS SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:POLARIS SPECIALTY PHARMACY, LLC
Other - Org Name:GOOD HEALTH INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-589-9747
Mailing Address - Street 1:2900 NW 60 STREET
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:800-589-9747
Mailing Address - Fax:954-923-9261
Practice Address - Street 1:410 CLOVERLEAF DRIVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-6511
Practice Address - Country:US
Practice Address - Phone:800-540-4700
Practice Address - Fax:800-540-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSC993613336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588753263Medicaid