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Organization
GOLDTREE RX LLC
Active
Organization
GOLDTREE RX LLC
Active
Other names
Hillmoor Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TOMA TOBIA (PHARMACIST/MANAGER)
(281) 827-4652
Entity
Organization
Contact information
Practice address
1401 SE GOLDTREE DR STE 103, PORT ST LUCIE, FL 34952-7584
(772) 237-4426
Mailing address
1401 SE GOLDTREE DR, UNIT 103, PORT ST LUCIE, FL 34952-7584
(772) 237-4426
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH26113
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5711773
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/14/2012
Last updated
11/13/2012
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