Provider Demographics
NPI:1144628413
Name:PHYSICIAN PREFERRED PHARMACY SPECIAL P/E
Entity type:Organization
Organization Name:PHYSICIAN PREFERRED PHARMACY SPECIAL P/E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-960-7360
Mailing Address - Street 1:2728 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5726
Mailing Address - Country:US
Mailing Address - Phone:954-233-4700
Mailing Address - Fax:
Practice Address - Street 1:2700 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5726
Practice Address - Country:US
Practice Address - Phone:954-960-7360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH237243336S0011X
FLPH287443336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000615500Medicaid
FL000615500Medicaid