1548314982 NPI number — INTEGRITY PHARMACY SERVICES LLC

Table of content: (NPI 1548314982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548314982 NPI number — INTEGRITY PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY PHARMACY SERVICES 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:
6
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:
1548314982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3802 CORPOREX PARK DR
Provider Second Line Business Mailing Address:
SUITE 200 - BILLING & COLLECT
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-318-6242
Provider Business Mailing Address Fax Number:
813-318-6725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3690 NW 53RD ST
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-717-4343
Provider Business Practice Location Address Fax Number:
954-717-4360
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANERIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
502-627-7100

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PH21987 , 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: 1010381 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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