1275835019 NPI number — CLINICAL CARE PHARMACY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275835019 NPI number — CLINICAL CARE PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL CARE PHARMACY, 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:
Provider Other Organization Name Type Code:
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:
1275835019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 NW 107TH AVENUE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-454-9852
Provider Business Mailing Address Fax Number:
305-556-6644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4765 W. 8TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-454-9852
Provider Business Practice Location Address Fax Number:
305-556-6644
Provider Enumeration Date:
11/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ALARCON
Authorized Official First Name:
XAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
305-534-0076

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108634100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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