1164820247 NPI number — ACARIAHEALTH PHARMACY, INC.

Table of content: (NPI 1164820247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164820247 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:
1164820247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8427 SOUTHPARK CIR STE 400
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:
32819-9057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-422-2742
Provider Business Mailing Address Fax Number:
866-834-8523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021-2 SANDY PKWY
Provider Second Line Business Practice Location Address:
SUITE A&B
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31909-1983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-511-5144
Provider Business Practice Location Address Fax Number:
877-541-1503
Provider Enumeration Date:
12/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-511-5144

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; 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" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE010102 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003155899A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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