Provider Demographics
NPI:1144283938
Name:ATENDA SPECIALTY INFUSION PHARMACY INC
Entity type:Organization
Organization Name:ATENDA SPECIALTY INFUSION PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR - AHS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-217-6055
Mailing Address - Street 1:15712 SW 41ST ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1538
Mailing Address - Country:US
Mailing Address - Phone:951-217-6055
Mailing Address - Fax:954-217-6062
Practice Address - Street 1:15712 SW 41ST ST
Practice Address - Street 2:SUITE 16
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-1538
Practice Address - Country:US
Practice Address - Phone:951-217-6055
Practice Address - Fax:954-217-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025274300Medicaid
FL0589370002Medicare ID - Type Unspecified