Provider Demographics
NPI:1134617517
Name:CARE CENTRIX PHARMACY LLC
Entity type:Organization
Organization Name:CARE CENTRIX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-432-0675
Mailing Address - Street 1:3585 MURRELL RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4779
Mailing Address - Country:US
Mailing Address - Phone:321-877-0539
Mailing Address - Fax:877-232-9689
Practice Address - Street 1:3585 MURRELL RD STE A
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4779
Practice Address - Country:US
Practice Address - Phone:321-877-0539
Practice Address - Fax:877-232-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH313643336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177405OtherPK