Provider Demographics
NPI:1033278130
Name:SHARED PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:SHARED PHARMACY SERVICES LLC
Other - Org Name:SHARED PHARMACY SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-251-5492
Mailing Address - Street 1:6149 CHANCELLOR DR
Mailing Address - Street 2:SUITE 2780
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5680
Mailing Address - Country:US
Mailing Address - Phone:407-251-5492
Mailing Address - Fax:407-251-5392
Practice Address - Street 1:6149 CHANCELLOR DR
Practice Address - Street 2:SUITE 2780
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5680
Practice Address - Country:US
Practice Address - Phone:407-251-5492
Practice Address - Fax:407-251-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH223673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002500OtherNCPDP PROVIDER IDENTIFICATION NUMBER