Basic Information
| Provider Information | |||||||||
| NPI: | 1063069607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASYSCRIPTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9250 W FLAGLER STREET, STE 600 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331743460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054488100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S HIATUS RD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330253617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544508722 | ||||||||
| FaxNumber: | 8448231708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | GERSTENKORN | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7864956409 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EASYSCRIPTS LLC | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | PH32237 | 01 | FL | FLORIDA BOARD OF PHARMACY | OTHER |