1710472451 NPI number — CARING RX, LLC

Table of content: (NPI 1710472451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710472451 NPI number — CARING RX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARING 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:
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:
1710472451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21002 S RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-402-8400
Provider Business Mailing Address Fax Number:
386-402-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21002 S RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-402-8400
Provider Business Practice Location Address Fax Number:
386-402-8487
Provider Enumeration Date:
06/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCOIS
Authorized Official First Name:
HERMAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
781-492-4639

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 102075100 . 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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