Provider Demographics
NPI:1346683216
Name:HOPE RISING ENTERPRISE LLC
Entity Type:Organization
Organization Name:HOPE RISING ENTERPRISE LLC
Other - Org Name:ARLINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-724-4337
Mailing Address - Street 1:936 ARLINGTON RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5956
Mailing Address - Country:US
Mailing Address - Phone:904-724-4337
Mailing Address - Fax:904-724-4329
Practice Address - Street 1:936 ARLINGTON RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5956
Practice Address - Country:US
Practice Address - Phone:904-724-4337
Practice Address - Fax:904-724-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH267573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139683OtherPK
FL008954900Medicaid