Provider Demographics
NPI:1144713850
Name:EIR HEALTH LLC
Entity type:Organization
Organization Name:EIR HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-218-3454
Mailing Address - Street 1:120 E MARKS ST
Mailing Address - Street 2:STE 250
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3857
Mailing Address - Country:US
Mailing Address - Phone:877-218-3454
Mailing Address - Fax:877-218-6461
Practice Address - Street 1:120 E MARKS ST
Practice Address - Street 2:STE 250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3857
Practice Address - Country:US
Practice Address - Phone:877-218-3454
Practice Address - Fax:877-218-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH314363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177876OtherPK