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Organization subpart
No

Provider details

NPI number
Authorized official
MR. CARLTON BRANKER (ADMINISTRATOR/OWNER)
(954) 557-4016
Entity
Organization

Contact information

Practice address
12277 SW 55TH ST, SUITE 908, COOPER CITY, FL 33330-3311
(754) 206-2934
Mailing address
2114 N FLAMINGO RD, SUITE 202, PEMBROKE PINES, FL 33028-3501
(754) 206-2934

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH29760
FL

Other

Enumeration date
02/24/2016
Last updated
02/24/2016
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