Provider Demographics
NPI:1730183310
Name:INTRAMED INC
Entity type:Organization
Organization Name:INTRAMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-214-7982
Mailing Address - Street 1:6950 CYPRESS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2382
Mailing Address - Country:US
Mailing Address - Phone:954-316-5054
Mailing Address - Fax:954-797-9205
Practice Address - Street 1:6950 CYPRESS RD STE 105
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2361
Practice Address - Country:US
Practice Address - Phone:866-999-0904
Practice Address - Fax:866-999-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH182453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026691400Medicaid
2014178OtherPK
FL026691401Medicaid