Provider Demographics
NPI:1679253231
Name:BELMAR PHARMACY FLORIDA, LLC.
Entity type:Organization
Organization Name:BELMAR PHARMACY FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEA AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-221-7800
Mailing Address - Street 1:231 VIOLET ST STE 140
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 LAKEPOINTE PKWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4374
Practice Address - Country:US
Practice Address - Phone:877-418-4692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELMAR MIDCO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy