Polypill Compound Medications LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PH25791 Issued in FL

Legal business name

POLYPILL COMPOUND MEDICATIONS LLC

Doing business as

Polypill Pharmacy

Practice address

4401 Sheridan St Ste B
Hollywood, FL 33021-3513

Phone

(855) 765-9745

Fax

(866) 355-0176

NPI assigned

Nov 11, 2011

Last updated

Nov 1, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Jackson

Title

VP Business Development

Phone

(407) 920-1155

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Polypill Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1164709663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 SW 134TH AVE",
            "city": "SOUTHWEST RANCHES",
            "state": "FL",
            "postal_code": "333303100",
            "telephone_number": "407-920-1155",
            "fax_number": "407-540-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 SHERIDAN ST STE B",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330213513",
            "telephone_number": "855-765-9745",
            "fax_number": "866-355-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLYPILL COMPOUND MEDICATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-11",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VP BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "407-920-1155"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "FL",
            "license": "PH25791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5709398",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polypill Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jennifer Pollak, MD
• Jaclyn Poma
• Ariela Pomper
• Joseph Daniel Pomper, DDS
• Anna Wanda Poniecka, M.D.
• Kerantha Poole-Christian, MA, SLP

• Compounding Pharmacy in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Compounding Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.