Provider Demographics
NPI:1164820247
Name:ACARIAHEALTH PHARMACY, INC.
Entity type:Organization
Organization Name:ACARIAHEALTH PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-511-5144
Mailing Address - Street 1:8427 SOUTHPARK CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9057
Mailing Address - Country:US
Mailing Address - Phone:855-422-2742
Mailing Address - Fax:866-834-8523
Practice Address - Street 1:3021-2 SANDY PKWY
Practice Address - Street 2:SUITE A&B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1983
Practice Address - Country:US
Practice Address - Phone:800-511-5144
Practice Address - Fax:877-541-1503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACARIAHEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 3336S0011X
GAPHRE0101023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003155899AMedicaid
6961350006Medicare NSC