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Organization
PRIME THERAPEUTICS PHARMACY LLC
Active
Organization
PRIME THERAPEUTICS PHARMACY LLC
Active
Other names
Magellan Rx Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW GLOVER (VP & GM SPECIALTY PHARMACY DIST)
(612) 777-4940
Entity
Organization
Contact information
Practice address
6870 SHADOWRIDGE DR STE 111, ORLANDO, FL 32812-9002
(866) 554-2673
(866) 364-2673
Mailing address
6870 SHADOWRIDGE DR, STE 111, ORLANDO, FL 32812-9002
(866) 554-2673
(866) 364-2673
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
Primary
PH19541
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031904000
—
FL
05
—
100265185-00
—
NE
05
—
101323804-0002
—
PA
05
—
1245241884
—
CT
05
—
1245241884
—
ID
05
—
1245241884
—
ME
05
—
1245241884
—
MI
05
—
1245241884
—
MN
05
—
1245241884
—
OH
05
—
1245241884
—
VA
05
—
1245241884
—
VT
05
—
1245241884
—
WA
05
—
1245241884
—
WI
05
—
1528692
—
TN
05
—
1612421
—
AK
05
—
200412310A
—
OK
05
—
200855460A
—
IN
01
—
2153807
PK
—
05
—
30708673
—
NH
05
—
415778800
—
MD
05
—
513347297001
—
IL
05
—
538884
—
NJ
05
—
54012687
—
KY
05
—
589259
—
AZ
05
—
600200927
—
MO
05
—
7F9541
—
SC
05
—
ATN66122
—
CO
Enumeration date
08/24/2015
Last updated
09/16/2024
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