Provider Demographics
NPI:1275835019
Name:CLINICAL CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:CLINICAL CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-534-0076
Mailing Address - Street 1:1400 NW 107TH AVENUE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:786-454-9852
Mailing Address - Fax:305-556-6644
Practice Address - Street 1:4765 W. 8TH AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3554
Practice Address - Country:US
Practice Address - Phone:786-454-9852
Practice Address - Fax:305-556-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108634100Medicaid