Provider Demographics
NPI:1114343084
Name:PRAXIS SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:PRAXIS SPECIALTY PHARMACY, LLC
Other - Org Name:PRAXIS RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-867-7162
Mailing Address - Street 1:5455 W WATERS AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1260
Mailing Address - Country:US
Mailing Address - Phone:888-903-7453
Mailing Address - Fax:
Practice Address - Street 1:5455 W WATERS AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1260
Practice Address - Country:US
Practice Address - Phone:888-903-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
FLPH280493336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy