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Organization
ERGOGENIC LABS LLC
Active
Organization
ERGOGENIC LABS LLC
Active
Other names
Ergogenic Labs LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT MANGINI (PHARMACY MANAGER)
(561) 408-2361
Entity
Organization
Contact information
Practice address
11496 PIERSON RD STE C6, WELLINGTON, FL 33414-8708
(561) 408-2361
(561) 408-2365
Mailing address
11496 PIERSON RD STE C6, WELLINGTON, FL 33414-8708
(561) 408-2361
(561) 408-2365
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PH27127
FL
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142715
PK
—
Enumeration date
10/21/2013
Last updated
12/19/2013
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