1386649747 NPI number — MEDISERV PHARMACY SERVICES LLC

Table of content: (NPI 1386649747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386649747 NPI number — MEDISERV PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDISERV 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:
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:
1386649747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5736 CLARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34233-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-927-2811
Provider Business Mailing Address Fax Number:
941-927-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5736 CLARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34233-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-927-2811
Provider Business Practice Location Address Fax Number:
941-927-2812
Provider Enumeration Date:
06/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLLINGSWORTH
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
941-927-2811

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH 19957 , 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: 1075084 . This is a "NABP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PH 19957 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".