Organization
PRIME PHARMACY, LLC
Active
Other names
Prime Pharmacy LLC, Prime Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHERAZ MIRZA (COO)
(904) 551-6555
Entity
Organization
Contact information
Practice address
7685 103RD ST STE 4, JACKSONVILLE, FL 32210
(904) 813-7634
(904) 551-6555
Mailing address
7685 103RD ST STE 4, JACKSONVILLE, FL 32210-9325
(904) 813-7634
(904) 551-6555
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24868
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002961800
—
FL
01
—
2126711
PK
—
Enumeration date
04/12/2010
Last updated
01/10/2019
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