Provider Demographics
NPI:1407156250
Name:PHARMLAND, LLC
Entity Type:Organization
Organization Name:PHARMLAND, LLC
Other - Org Name:LIFECARE PHARMACY LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MAZARIEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:727-209-1283
Mailing Address - Street 1:3426 13TH AVE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5424
Mailing Address - Country:US
Mailing Address - Phone:727-209-1283
Mailing Address - Fax:727-209-1281
Practice Address - Street 1:3426 13TH AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5424
Practice Address - Country:US
Practice Address - Phone:727-209-1283
Practice Address - Fax:727-209-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH249673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000609300Medicaid
6245520002Medicare NSC