1538600424 NPI number — CAN COMMUNITY HEALTH INC.

Table of content: (NPI 1538600424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538600424 NPI number — CAN COMMUNITY HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAN COMMUNITY HEALTH INC.
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:
CAN COMMUNITY HEALTH PHARMACY OF JACKSONVILLE
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:
1538600424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 N NEBRASKA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33602-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-871-5161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4615 PHILIPS HWY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-9506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-370-6204
Provider Business Practice Location Address Fax Number:
904-647-3419
Provider Enumeration Date:
03/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KALARIA
Authorized Official First Name:
HANSIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMACY OFFICER
Authorized Official Telephone Number:
813-871-5161

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH31165 , 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: 102229300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2170568 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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