Provider Demographics
NPI: | 1144231788 |
---|---|
Name: | DIRECT PHARMACY SERVICES INC |
Entity Type: | Organization |
Organization Name: | DIRECT PHARMACY SERVICES INC |
Other - Org Name: | DIRECT PHARMACY SERVICES INC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP OF VENDOR RELATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHIULING |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-918-1714 |
Mailing Address - Street 1: | 9332 ANNAPOLIS RD |
Mailing Address - Street 2: | STE 211 |
Mailing Address - City: | LANHAM |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20706-3113 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-918-1711 |
Mailing Address - Fax: | 301-918-1717 |
Practice Address - Street 1: | 6635 W COMMERCIAL BLVD |
Practice Address - Street 2: | SUITE 116 |
Practice Address - City: | TAMARAC |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33319-2100 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-720-0222 |
Practice Address - Fax: | 954-720-0336 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-10 |
Last Update Date: | 2015-04-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 183500000X, 1835G0303X, 1835N0905X, 1835N1003X, 1835P0018X, 1835P1200X, 1835P1300X, 1835X0200X, 333600000X | |
FL | PH22076 | 3336C0003X |
3336C0004X, 3336L0003X, 3336M0002X, 3336S0011X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy | Group - Multi-Specialty |
No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
No | 1835G0303X | Pharmacy Service Providers | Pharmacist | Geriatric | Group - Multi-Specialty |
No | 1835N0905X | Pharmacy Service Providers | Pharmacist | Nuclear | Group - Multi-Specialty |
No | 1835N1003X | Pharmacy Service Providers | Pharmacist | Nutrition Support | Group - Multi-Specialty |
No | 1835P0018X | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | Group - Multi-Specialty |
No | 1835P1200X | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | Group - Multi-Specialty |
No | 1835P1300X | Pharmacy Service Providers | Pharmacist | Psychiatric | Group - Multi-Specialty |
No | 1835X0200X | Pharmacy Service Providers | Pharmacist | Oncology | Group - Multi-Specialty |
No | 333600000X | Suppliers | Pharmacy | Group - Multi-Specialty | |
No | 3336C0004X | Suppliers | Pharmacy | Compounding Pharmacy | Group - Multi-Specialty |
No | 3336L0003X | Suppliers | Pharmacy | Long Term Care Pharmacy | Group - Multi-Specialty |
No | 3336M0002X | Suppliers | Pharmacy | Mail Order Pharmacy | Group - Multi-Specialty |
No | 3336S0011X | Suppliers | Pharmacy | Specialty Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | P008009737 | Medicaid | |
1019909 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
MD | 014010400 | Medicaid | |
MI | P008009737 | Medicaid |