1770090482 NPI number — EVENTUS RX 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 1770090482 NPI number — EVENTUS RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVENTUS RX 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:
1770090482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6912 S QUENTIN ST STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-282-5325
Provider Business Mailing Address Fax Number:
877-676-0493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11300 LINDBERGH BLVD STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33913-8827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-249-2696
Provider Business Practice Location Address Fax Number:
866-330-7487
Provider Enumeration Date:
01/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SILOLAHTI
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP MANAGED CARE CONTRACTING
Authorized Official Telephone Number:
720-282-2382

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH31110 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NCPDP . This is a "5736725" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PH31110 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114607300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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