Organization
HILLMOOR PLAZA PHARMACY INC
Active
Other names
IV PLUS
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA WEIDEMAN PHARM D (CEO)
(772) 468-0074
Entity
Organization
Contact information
Practice address
9312 FOREST HILL BLVD, WELLINGTON, FL 33411-6577
(561) 753-6768
(561) 753-6763
Mailing address
9312 FOREST HILL BLVD, WELLINGTON, FL 33411-6577
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH13112
FL
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102866900
—
FL
05
—
102866901
—
FL
05
—
102866902
—
FL
01
—
1075022
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/20/2006
Last updated
05/13/2009
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