Provider Demographics
NPI:1053746727
Name:SIMFAROSE PHARMACEUTICAL SPECIALTY, INC
Entity type:Organization
Organization Name:SIMFAROSE PHARMACEUTICAL SPECIALTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-435-7200
Mailing Address - Street 1:10016 PINES BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-435-7200
Mailing Address - Fax:954-438-1030
Practice Address - Street 1:10008 PINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-435-7200
Practice Address - Fax:954-438-1030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMFAROSE PHARMACEUTICAL SPECIALTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-12
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25447261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy