1396917381 NPI number — PARTNERS PHARMACY OF FLORIDA, LLC

Table of content: MRS. KAREN SETA MOORE OTR/L (NPI 1366152910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396917381 NPI number — PARTNERS PHARMACY OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS PHARMACY OF FLORIDA, 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:
6
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:
1396917381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 LAWRENCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07081-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-563-4592
Provider Business Mailing Address Fax Number:
407-829-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 SKYLINE DR
Provider Second Line Business Practice Location Address:
SUITE 1011
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-6224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-805-8300
Provider Business Practice Location Address Fax Number:
407-829-7346
Provider Enumeration Date:
03/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GLADWELL
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF THIRD PARTY ADMINISTRAT
Authorized Official Telephone Number:
908-931-9111

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PH26431 , 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: 2011282 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com