1609054808 NPI number — MEDICAL ARTS PHARMACY SERVICES

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 1609054808 NPI number — MEDICAL ARTS PHARMACY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ARTS PHARMACY SERVICES
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:
MEDICAL ARTS PHARMACY SERVICES
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:
1609054808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10412 W ATLANTIC BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071-5605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-541-8201
Provider Business Mailing Address Fax Number:
954-827-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10412 W ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33071-5605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-541-8201
Provider Business Practice Location Address Fax Number:
954-827-0616
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
LANCELOT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-541-8201

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH22434 , 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: 2010743 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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