1033278130 NPI number — SHARED PHARMACY SERVICES LLC

Table of content: (NPI 1033278130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033278130 NPI number — SHARED PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARED PHARMACY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHARED PHARMACY SERVICES LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033278130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6149 CHANCELLOR DR
Provider Second Line Business Mailing Address:
SUITE 2780
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32809-5680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-251-5492
Provider Business Mailing Address Fax Number:
407-251-5392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6149 CHANCELLOR DR
Provider Second Line Business Practice Location Address:
SUITE 2780
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-5680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-251-5492
Provider Business Practice Location Address Fax Number:
407-251-5392
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
HAVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-251-5492

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PH22367 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1002500 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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