1104827724 NPI number — PRIORITY HEALTHCARE PHARMACY INC.

Table of content: (NPI 1104827724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104827724 NPI number — PRIORITY HEALTHCARE PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY HEALTHCARE 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:
1104827724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6272 LEE VISTA BLVD
Provider Second Line Business Mailing Address:
LEGAL DEPT
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-5148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-773-7376
Provider Business Mailing Address Fax Number:
888-773-7386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 TECHNOLOGY PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-7115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-892-9622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
407-854-6532

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH16300 , 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: 1070666 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91230100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH905FL , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3116440 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533851 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1269859 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22106600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 498007 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54000435 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84326581 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212041 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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