1912016940 NPI number — ACARIAHEALTH PHARMACY, INC.

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 1912016940 NPI number — ACARIAHEALTH PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACARIAHEALTH PHARMACY, 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:
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:
1912016940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6923 LEE VISTA BLVD., SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-903-1308
Provider Business Mailing Address Fax Number:
407-903-1323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8505 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-846-9912
Provider Business Practice Location Address Fax Number:
703-846-4998
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
407-903-1335

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 034613100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912016940 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N3823 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 401564900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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