Provider Demographics
NPI:1386649747
Name:MEDISERV PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MEDISERV PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:941-927-2811
Mailing Address - Street 1:5736 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3302
Mailing Address - Country:US
Mailing Address - Phone:941-927-2811
Mailing Address - Fax:941-927-2812
Practice Address - Street 1:5736 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3302
Practice Address - Country:US
Practice Address - Phone:941-927-2811
Practice Address - Fax:941-927-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 19957333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1075084OtherNABP NUMBER
FLPH 19957OtherPHARMACY LICENSE
FLPH 19957OtherPHARMACY LICENSE