<Unavail>

LBN: Providence Pharmacy Llc
<Unavail> is an health care organization with primary practice located at 5515 Us Highway 98 N Ste 1 , Lakeland FL 33809-3133. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Providence Pharmacy Llc can be contacted via phone (863) 937-8092, or through Asante, Edwin via phone (863) 937-8092.

Contact Information

Primary practice address
5515 Us Highway 98 N Ste 1 Lakeland FL 33809-3133
Phone: (863) 937-8092
Fax: (863) 937-8093
Website:
Map and Directions
Authorized official contact:
Name: Asante, Edwin
Phone: (863) 937-8092

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PH27055 Florida

Profile Details

NPI number 1568891125
LBN Legal business name Providence Pharmacy Llc
DBA Doing business as <Unavail>
Authorized official Asante, Edwin
Entity Organization
Organization subpart 1 No
Enumeration date Nov 4th, 2013
Last updated Jan 20th, 2017 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568891125 NPPES
Other 2143281 PK
MEDICAID 010969100 PK

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