Provider Demographics
NPI: | 1255301586 |
---|---|
Name: | ORANGE BELT PHARMACY INC. |
Entity Type: | Organization |
Organization Name: | ORANGE BELT PHARMACY INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHARMACY MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | HUGHES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 386-734-1685 |
Mailing Address - Street 1: | 112 E NEW YORK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DELAND |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32724-5504 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 386-734-1685 |
Mailing Address - Fax: | 386-736-2600 |
Practice Address - Street 1: | 112 E NEW YORK AVE |
Practice Address - Street 2: | |
Practice Address - City: | DELAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32724-5504 |
Practice Address - Country: | US |
Practice Address - Phone: | 386-734-1685 |
Practice Address - Fax: | 386-736-2600 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-01-26 |
Last Update Date: | 2008-02-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
172A00000X, 183700000X, 225000000X, 227900000X, 332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 335E00000X | ||
FL | PS16836 | 183500000X |
FL | PH192 | 333600000X, 3336C0003X, 3336C0004X, 3336H0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy | |
No | 172A00000X | Other Service Providers | Driver | Group - Multi-Specialty | |
No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
No | 183700000X | Pharmacy Service Providers | Pharmacy Technician | Group - Multi-Specialty | |
No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
No | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Group - Multi-Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | Group - Multi-Specialty |
No | 332BP3500X | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | Group - Multi-Specialty |
No | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | |
No | 333600000X | Suppliers | Pharmacy | ||
No | 3336C0004X | Suppliers | Pharmacy | Compounding Pharmacy | |
No | 3336H0001X | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | |
No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 0378060001 | Medicare ID - Type Unspecified | PROVIDER ID |