Provider Demographics
NPI:1902977416
Name:FLORIDA INFUSION SERVICES, INC.
Entity Type:Organization
Organization Name:FLORIDA INFUSION SERVICES, INC.
Other - Org Name:FLORIDA INFUSION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-943-9900
Mailing Address - Street 1:4190 CORPORATE COURT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1412
Mailing Address - Country:US
Mailing Address - Phone:727-943-9900
Mailing Address - Fax:727-943-0852
Practice Address - Street 1:4190 CORPORATE COURT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1412
Practice Address - Country:US
Practice Address - Phone:727-943-9900
Practice Address - Fax:727-943-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH9911332BP3500X
FLPH 9911333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPROVIDER NUMBER
FL0175650001Medicare ID - Type UnspecifiedPROVIDER NUMBER