<Unavail>

LBN: Revive Pharmacy Inc
<Unavail> is an health care organization with primary practice located at 16205 S Tamiami Trl Suite # 6, Fort Myers FL 33908-5304. 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. Revive Pharmacy Inc can be contacted via phone (239) 204-4223, or through Deforte, Nicole via phone (239) 204-4223.

Contact Information

Primary practice address
16205 S Tamiami Trl Suite # 6 Fort Myers FL 33908-5304
Phone: (239) 204-4223
Fax: (239) 204-4224
Website:
Map and Directions
Authorized official contact:
Name: Deforte, Nicole
Phone: (239) 204-4223

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PH26342 Florida

Profile Details

NPI number 1558610527
LBN Legal business name Revive Pharmacy Inc
DBA Doing business as <Unavail>
Authorized official Deforte, Nicole
Entity Organization
Organization subpart 1 No
Enumeration date Sep 5th, 2012
Last updated Feb 26th, 2016 - about 10 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 1558610527 NPPES
Other 2136822 PK
MEDICAID 006790300 PK

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